Loading...
HomeMy WebLinkAbout0128 CEDRIC ROAD - Health 128 CEDRIC RD., CENTERVILLE A=172 - 137 i MADE IN LL" �MEM c� Commonwealth of Massachusetts /T o2 — f s+ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information S1 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Betdan Lane VQ Company Address Centerville Ma 02632 Cityrrown State Zip Code 774-2484850 smjonestitle5@gmail.com, S14522 sean@smjonestitte5.com License Number B. Certification I certify that: 1 am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Au or-ity 4. ❑ Fails 6/2/2020 Inspector's Signature Date The system inspectors submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Cedric Road V Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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 property located at 128 Cedric Rd Centerville is served by a Title V septic system consisting of 2 1000 gallon septic tanks in series, distribution box and a 25'x13' leach field with 16 Hi Cap Infiltrators. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form .i nsp Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road u Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3 Further v 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. a. 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �a 128 Cedric Road u Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) 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 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 ` 128 Cedric Road u Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® 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 1/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. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 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. 5) 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 CA. 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 I I of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts 1, Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is Centerville Ma 02632 6/2/2020 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No N ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owners Name information is required for every Centerville Ma 02632 6/2/2020 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 1 Does residence have a garbage grinder? ® Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes Z No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �..V 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract El Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: system repaired 11/10/2011 per town records Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5. Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 & 1' feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons & 1000 gallons Sludge depth: 5" &3" Distance from top of sludge to bottom of outlet tee or baffle T &3' Scum thickness 2" & 1" Distance from top of scum to top of outlet tee or baffle 7"&7° Distance from bottom of scum to bottom of outlet tee or baffle 101, & 101, How were dimensions determined? Opened covers and took measurements Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Property is served by 2 1000 gallon septic tanks in series. 1st tank is original for house, 2nd tank and d-box leaching field installed 2011 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c~ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road V Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): 0il Depth of liquid level above outlet invert Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form (' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - � 128 Cedric Road u Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ED leaching chambers number: 16 Hi Cap Infiltrators ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is Centerville Ma 02632 6/2/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): s.a.s. consists of 16 Hi Cap Infiltrators in a 25'x13'field. No signs of past hydraulic overloading, no lush vegetation, no damp soil. 12. 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u 128 Cedric Road Property Address Swimm Owner Owner's Name information is Centerville Ma 02632 6/2/2020 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately <3 2 � 3 b A( 33 A-Y t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owner's Name information is required for every Centerville Ma 02632 6/2/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 128 Cedric Road Property Address Swimm Owner Owners Name information is required for every Centerville Ma 02632 6/2/2020 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary:' 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 No. �c " 351 Fee �W THE COMMONWEALTH OF MASSACHUSETTS F;ntered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for imisposal 6pstem Construction permit Application for a Permit to Construct( ) Repair(!/upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address C,6� C. v %/ Owner's Name,Address,and Tel.No.o Lot o. Assessor's Map/Parcel -' 7 1, ra 4F Install e 's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building S No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided .3 gpd Plan Date �� /� Number of sheets Revision Date Title Size of Septic Tank X r Y /v U D Type of S.A.S. /G �-�< <,eo� �,,/ I/1'a2 4 Y.0 �2 S Description of Soil \ re d Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and of to pl e the syst in operation until a Certificate of Compliance has been issued by this Board of He Signed Date 6 Z/i l Application Approved by Date Application Disapproved by Date for the following reasons Permit No. aot 1— 3 573 Date Issued 10-17— I 1 --------------------------------------------------------------------------------------------------------------------------------------- �l,I — 353 �a No. I I 0 ! ¢ Fee / d tered in compute THE COMMONWEALTH OF MASSACH.US TTS� __4 h �15L"TC HEALTH DIVISION - TOWN OFBARNSTABLE MASSACHUSETTS s`Yes' .`"_01pplicatlon for IMisposal 6pstem Construction Permit Application for a Permit to Construct( ) %'Repair( Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address o Logo. � C�,�T��,,,//� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installe 's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. S- J S i Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) i Other Type of Building /7 No.of Persons Showers( ) Cafeteria( ) i Other Fixtures Design Flow min.required) 3 U g ( q ) gpd Design flow provided 3 gpd i Plan Date � � 6 � // Number of sheets Revision Date Title Size of Septic Tank c T /U U!� - X Type of S.A.S. / �a/r-/ >`�"• � / ,' i Description of Soil i zc Nature of Repairs or Alterations(Answer when applicable) j 1 S i 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 syste in operation until a Certificate of Compliance has been issued by this Board of Healt . / Signe Date Application Approved by (15 Date i __ Application Disapproved ,by Date i for the following reasons Permit No. ;Ot 1— 353 Date Issued t O !S- THE COMMONWEALTH OF MASSACHUSETTS F BARNSTABLE,MASSACHUSETTS ` (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed-,( ) Repaired( ) Upgraded( ) Abandoned( )by 4 2 at l oZ �& y/L G o xo G-' has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer �� Designer (^ A y 6 "� A #bedrooms Approved_`design gpd r The issuance o thi permit shall not be construed as a guarantee that the system w'll fit c on as des •n d. P Date � ) Inspector i -----------------------------------------------------------------------------------------------------------------------)-/----------------- No. Fee j THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Bisposai *pstem Construction Permit Permission is hereby granted to Construct( ) Repair U grade( ) Abandon( ) System located at ��=A2 D� 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. F Provided:Construction must be completed within three years of the date of this permit, 6L,.--� � Date 1 V—11 Approved by l� 02/10/2022 01 :44 FAX 001/001 Town of Barnstable /� ` ltegxl4itory services \c\\ Thon►w- F. (;cilu, Director nAllk3TABLE) I� public Health Division '1\9\ MARS. g Thomas \'IeKean, Director ?11(I Maio Sn'ect, Il��anuis, MA (?2btl! l-tla' 508-790-6104 U11icc: -'M-862-4644 �1 1)a[c: II L J Sowa • 1'c1,1110 �r" A�,v.tisnr'ti I 'IalA),ueel Instil ter& l7ctiiuncr ( rrtit�c�t[ictu I�urul 4 � Designer:' -- i�¢t�fE. t`t�3`�—.-. Installer �--Zuc i Oil_ - -- _ - S"r tv�.� ed .l per, ?it tti instal! a (date) (iltst'�llet'1 septic s)'stcrl ilt - -- — —. baa�cl oil de,i��n drawn by (acid rc s�.j dated _ I cerfi'1, lhfr. the tiepliC .ys'.Cttt lCltl'C'lt�C! Q.IUVe �>Llti IIISLiIIICCI acc01'dill" l'O the desi311, which may i Maude minor nllhrovuJ chap.es SLICK, , lateral rcloeaLiol: ;tf dte distribution L1c,� alldVor' optic Lank uihl uI OF R:quit•°20 vv ' inspNCLed and :hc soils were Cctund ,ati.ltl .tot'y. _ I certify :haL (he ,LptiC ystem MR-I'cncrcl ;the,Ve wil, 1111,talkcd With Ill-11jar clla119es (i.e. LrCat�l'thil[t 1) LiteralP-location Ul IhC h \1 or am 1'41'lIL'itl I'Ll )l:lllUlt il: am, t't11111JUt1C11L tai"the tie(nic slyrn) lau :n accordnlcc will., Mitt 6", Local Rey tlltrions. P1,1111"t:VISion or ccrtiiied W-huill h� desis;rtcr to fall( �.� �lrilr,Lli til'required) 'Is ulsllecrccl and the s:iil� �aerc (crund (In�ta lrr', inrilLlr' Iu r el'c) PLI�ASC 12C?'TURN TO BA STABLE I'1 BLAC: HEALTH I'.1f1% sloN. Cr.,ffnFTcArF,, OF COIv1PL1ANCE WILL NOT BE ISSU171) UNTIL B()'FH l: rOizivT JVIEIN 1) N, 13UTT7 CART) AIZE RECET EI) ily THE BA,RhSTABLE PURL C HEALTH T)ZViSXON. .I`J(I C, I111175`t%1ti r_OCI C��1C i.:l�?i li,;��doe TOWN OF BARNSTABLE LOCATION L X ir C E cQa i SEWAGE#2,9 3 �.3 VILLAGECZ Me- ASSESSOR'S MAP&PARCEL I-7 Z — t 3 ) INSTALLER'S NAME&PHONE NO. P,2 c rr l%NsT S'o 7 s c 3 d z- SEPTIC TANK CAPACITY goe, s i io o y ,a U n.E w l o o o LEACHING FACILITY.(type) 16 NO.OF BEDROOMS OWNER BAat J19&P PERMIT DATE: 10/G Ao 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) Feet FURNISHED BY U. oo � w G ® /3L G o r , 13 • ate Town of Barnstable P# Departiment of Regulatory Services ' Public Health Division Date 200 Main Street,Hyannis MA 02601 Date Scheduled h1h Time Fee Pd. Soil Suitability Assessment for Se e Disposal Performed By: Witnessed By: LOCATION& GENERAL INFORMATION Location Address a O �;C t Owner's Name S F`ID �J�� �w►M S`(� CAP �•`�e Address Assessor's Map/Parcel: 1 I I Engineer's Name CO3Q_t 1r_—V4 S W Py NEW CONSTRUCTION 1 \REPAIR Telephone# Land Use: S\C��'t-�Q� Slopes(%) 1070 Surface Stones ,N A_ Distances from: Open Water Body IJ _ft Possible Wet Area_ NIA R Drinking Water Well �ft Drainage Way P 1 A ft Property Line ft ft Other ft SKETCH:(street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) CD 1 �p1 p C yrwa • FCon�- Parent material(geologic) epth to Bedrock A Depth to Groundwater. Standing Water in Hole: 1J O� ��Weeping from Pit Face t-Jc P Estimated Seasonal High Groundwater 3;2 ►► A SS.,rnQT_ s DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs,hole: _ ____ 1u, .Depth to soil mottles: In. Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level ' Adj.factor— Adj.Groundwater Level,, PERCOLATION TEST bate,.91 d!1 Tltne 1!:o e Observation Hole# ( Time at 4" 1 L . Lq I C Depth of Pero 42, —(,eP Time at 6" � 30 Start Pre-soak Time 5 Time(9"-6") 3 m to 30c" End Pre-soak Rate MinJlnch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1) week prior to beginning. Q:\S EPTIC\PERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# ( _ Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. o i ten=v.4b'Gravell - �a �Q •�L �a�te. �l� N � F' - . ------------ 19, . . n -LAa, ' LS o She a- Cl abbles j5coact DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten %Gravel) NIL) F ,46 - 1 C r, - �- a, 16�ld ( t61de1eS DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consistency. Flood Insurance Rate Mau: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes.. Within 100 year flood boundary No. Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring perviou material exist in all areas observed throughout the area-proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? .__...___.�. Certification I certify that on 11101 , (date)I have passed the soil evaluator examination approved by the Department of Environmental r e do nd that the above analysis was performed by me consistent with . the required trainin exp se' x ri nce described in 310 CMR 15.017. d Signature - Date Q:1S.EPTICVERCFORM.DOC oF _�FTo�` TOWN OF BARNSTABLE d OFFICE OF i DAH M"" i BOARD OF HEALTH � A/0. o39.k� 367 MAIN STREET MAI HYANNIS, MASS.02601 June 11, 1998 Cosmos Caterino 230 Cedric Road Centerville, MA 02632 RE: Conditional Approval 128 Cedric Road Centerville,!MA Dear Mr. Caterino: You are granted permission to construct an addition at 128 Cedric Road, Centerville with the following conditions: (1) No more than three(3)bedrooms are authorized. Dens, study-rooms, offices, finished attics, sleeping lofts, and similar rooms are considered bedrooms according to MA Department of Environmental Protection. (2) The applicant shall record a deed restriction at the County Registry of Deeds which states: "This dwelling shall contain no more than three(3)bedrooms total" (3) The existing bedrooms, located adjacent to the"master bedroom"shall be converted to a sitting room as proposed by the applicant. The doors must be removed from the entrances to this room in order to ensure there is no privacy in this room. This room shall not be utilized for sleeping purposes. (4) The proposed"lanni"shall not be used for sleeping purposes. This room shall be constructed in such a manner so that it will not meet the State Environmental Code, Title V definition of a bedroom. This permission is granted because the existing septic system was originally designed to handle three (3) bedrooms. The addition will consist of an in-law apartment. A total of(3) bedrooms are needed for the three occupants who will reside there, a grandchild,mother,and grandmother. Sincerely yours, us� .S. Chairperson Board of Health Town of Barnstable caterino 00 rib 00 ..r v < OWN v� r- N �0db o � two th � 1'1 V Pam ' s s r 06/29/1998 15:36 5087756029 JQ_TRJM9AW PAGE 01 Eiati 1 ' P13,0 i"`i> 4 r T 1. f_i.3 : CA4 TOWN Of BARNSTABLE OFFICE OF '•'NA:., i BOARD OF HEALTH ielP 111f AP� 367 MAIN STREET HYANNIS. MASS, 02601 June 11, 1998 Cosmos Caterino 230 Cedric Road Centerville, MA 02632 RE: Conditional Approval 128 Cedric Road Centerville, MA Dear Mr. Caterino- You are granted permission to construct an addition at 128 Cedric Road, Centerville with the following conditions- (1) No more than three(3)bedrooms are authorized. Dens,study-rooms,offices, finished attics,sleeping logs, and similar rooms are considered bedrooms according to MA Department of Environmental.Protection.. (2) The applicant shall record a deed restriction at the County Registry of Deeds which states: "This dwelling shall contain no more than three(3)bedrooms total" (3) The existing bedrooms, located adjacent to the"master bedroom"shall be converted to a sitting roan,as proposed by the applicant. The doors must be removed from the entrances to this room in order to erasure there is no privacy in this room. This room shall not be utilized for sleeping purposes. (4) no proposed`lanni"shall not be used for sleeping purposes. This room shall be constructed in such a manner so that it will not meet the State Environmental Code, Title V definition of a bedroom. This permission is granted because the existing septic system was originally designed to handle three(3) bedrooms, The addition will consist of an in-law apartment. A total of(3) bedrooms are needed for the three occupants who will reside there,a grandchild,mother, and grandmother. Sincerely yours, usan G, liast.S. Chairperson Board of Health Town of Barnstable caterin0 r CERTIFICATE I, John W. Kenney, certify that I am an attorney at law with offices at Centerville, Massachusetts, and that the facts stated in the foregoing letter are elevan of to bthe t c a:sdtile tQase'�the tance�ain therein described and will beclarifying the chain of title thereto. Its ney, ttorney c . - 'r•cn oar,T/AF/90 Q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION REPORT Date: V j °!r -rj(j'f .� Property address: 12 8 GS=7eic- tO.,oE"TGM\/oL�, �-A, i7Z' ��" V3 Owner: 84912�61� S W i►- A Inspector: Tristram Weller PART A CERTIFICATION 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 inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes Needs Further Evaluation By the Local Approving Authority Flails Signed: 1'� � Date: C,,,-0j—q95 INSPECTION SUMMARY: A] SYSTEM PASSES I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system,upon completion of the replacement or repair,passes inspection. The septic tank is metal,cracked,structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled,or uneven distribution box. The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four(4)times a year due to broken or obstructed pipe(s). The system will pass if(with the approval of the Board of Health): broken pipe(s)are replaced obstruction is removed Cl 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 the public health, safety,and the enviroment. SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIROMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or salt marsh SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIROMENT: The system has a septic tank and soil absorption system and is within 100 feet of a surface water supply or a tributary to a surface water supply The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volitale organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitro- gen is equal to or less than 5 ppm D] SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. . Backup of sewage into facility or system component due to an 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 1/2 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 soil absorption system,cesspool,or privy is below the high ground- water elevation Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to surface water supply Any portion of a cesspool or privy is within a Zone I 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria, volatile organic compounds,ammonia nitrogen and nitrate nitrogen. 4 E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above: The design flow of system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the enviroment because one or more of the following conditions exist: 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 nitogen sensitve area(Interim Wellhead Protection Area (IWPA)or a mapped Zone II of a public water supply well The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. PART B CHECKLIST �C Pumping information was requested of the owner, occupant,or Board of Health None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of the inspection As-built plans have been obtained and examined The facility or dwelling was inspected for signs of sewage back-up The system does not receive non-sanitary or industrial waste flow k The site was inspected for signs of breakout All system components,excluding the soil absorption system,have been located on the site The septic tank manholes were uncovered,opened,and the interior of the septic Tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge, and depth of scum The size and location of the soil absorption system on the site has been determined based on existing information or approximated by non-intrusive methods X The facility owner and/or occupants were provided with the information on the proper maintenance of subsurface sewage disposal systems PART C SYSTEM INFORMATION FLOW CONDITIONS RESIDENTIAL: Design flow: F—X.1S'Tt 1 ZZ_ Number of bedrooms: 'L Be4:;P 5 Number of current residents: 7 -iz�s� C� �� Garbage grinder: N0 / Laundry: -j�E S Seasonal use: AO Water meter readings: Last date of occupancy: 1 t4v_ COMMERCIALANDUSTRIAL Type of establishment: Design flow: Grease trap: Industrial Waste Holding Tank: Non-sanitary waste discharged: Water meter readings: Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS: Last pumped: Source of information: o System pumped as part of inspection: Volume pumped: 1cx>0 CA.,ajt... Reason for pumping: V t ,, t J TYPE OF SYSTEM: _ C Septic absorption system Single cesspool Overflow cesspool Privy Shared system Other Date installed: V-104- Source of information: rovvlr3 ®faJ� Xa Sewage odor detected: 'VJ c� i SEPTIC TANK: i1 Depth below grade: `Z Material of construction: Dimensions:4,e x SI CiL x 410" Sludge depth: 3 1 N Top of sludge to bottom of outlet tee: Z Scum thickness: t" Top of scum to top of outlet tee: Bottom of scum to bottom of outlet tee: IV Comments: 'V-4Y. k:5 Z� Ca- 1.� "L r3`1� ► s =wti��N� 1 r„1 n2os TPI-E 1:--a7LJEA- GREASE TRAP: Q0 Depth below grade: Material of construction: Dimensions: Scum thickness: Top of scum to top of outlet tee: Bottom of scum to bottom of outlet tee: Comments: TIGHT OR HOLDING TANK: Depth below grade: Material of construction: Dimensions: Capacity: Design flow: Alarm level: Comments: DISTRIBUTION BOX: IVt Depth of liquid level above outlet invert: Comments: PUMP CHAMBER: Pumps in working order: Comments: SOIL ABSORPTION SYSTEM: Type of system:(i) ` PECP6 L-orjc� AssQ,4x-- I,' of- � Comments: -j j c g0.ca� ®E Aks A 'TD--- �c o� T—' c?— Suit"- jr -Ta � { CESSPOOLS: j� 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: Comments: PRIVY: f s*PIE- Materials of construction: Depth of solids: Comments: SKETCH OF SEWAGE DISPOSAL SYSTEM: 00 DEPTH TO GROUNDWATER Depth: We, �►����.�� 'ram l`3� 3` 'Bl;��, '���,rA o f 1 i Method of determination: `s l i i I illcKean Thomas To: Lavoie Debbra Subject: 230 Cedric Road Centerville/ Request to Construct a Family Apartment. The newly revised sketch (revised May 18, 1998) now shows a total of two (2) bedrooms. This newly revised sketch plan is now in conformance with the State Environmental Code, Title V. I initialed that sketch on the bottom right hand corner indicating that I have no objections, dated it, and handed it to Mr. Cosmo Caterino on May 18, 1998. HISTORY The property is located within a zone of contribution to public water supply wells. The existing home consists of two bedrooms. The applicant, Cosmos Caterino, originally requested permission to contruct two additional bedrooms, for a total of four (4) bedrooms on a 15,000 square feet lot. Health Inspector Jerome Dunning informed Mr. Caterino that this request cannot be approved because it conflicts with the State Environmental Code, Title V. Then, Mr. Caterino left the office, revised the floor plan to show only one additional bedroom and re-labeled the second room as a "living-room." That plan showed a total of three (3) bedrooms. Then, on May 18, 1998, Mr. Caterino returned to the Public Health Division Office and requested a written approval letter of that floor plan. I informed him that I cannot approve an additional bedroom on this lot because of the nitrogen loading regulation contained in Title V, limiting the sewage flow to 440 gallons per acre per day. I handed Mr. Caterino a copy of the regulation. I then informed him that he could go before the Board of Health next Tuesday night (May 26, 1998) to request a variance from 310 CMR 15.214. Mr. Caterino answered " I have to go to a ZBA hearing this Wednesday night." Then while at the counter, he changed the floor plan by eliminating a door to one of the existing bedrooms (stating it will have a four feet wide opening) and by re-labeling that room as a "sitting room." The floor plan now shows a total of two (2) bedrooms. From: Lavoie Debbra To: Crossen Ralph; McKean Thomas Subject: Swimm Family Apt. Date: Monday, May 18, 1998 10:13AM Priority: High Attached are the minutes from the hearing regarding Swimm Mr. Caterino is supposed to get approval in writting from the Building and Health Dept. Thanks< <File Attachment: 199864.DOC> > 1f� I LN t Page 1 2 � la);w1M -40 a _ bx ►: I ©�.� Roots .. mC, , To SIT V \„� =D40e 7N t►�- � klTc►,eN C o _ - - ----� ��c ►s 7�Luc, AN N I eaT IL (Fk A. ROOM r I • — SAT �oS Gtos Eil+ST1A16 Noks - - K +Tcrle� �N � o 'M. I FA,+n may N �, = M ASrer 'Roc «► -- �`.�°L L1V INC e - 3/0 i SITE LOCUS OL D STAGE RD ASHLEY LN *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. ��V 4 VENT PIPE(O Least 24 Inches tall) Schedule 40 PVC w/Charcoal Odor filter ( Lai to 10' min. from r� J �o �1 ESTABLISHED VEGETATIVE COVER SITE �' g Existing Foundation house to septic tank D-BOX Dover must !» %� ) �1 0 Provide.Rissrs if necessary Provide Risen If necessary p( O o g' BASEMENT FLOOR SLAB ELEV. 100.00 ary to brinp se is tank coven within a In. of finished grove to brinq•Septta tank cows within 6" O finished grade orads owr D-vox-seoo am SAs-9eoo y , +. �.• BACKFlLL WITH CLEAN SAND q9 0 within 8 of finished grade .,.., : » •. •.:..:r :+� ,.:, �.;,:,...,'r.;:,. +` (NATIVE OR PERC SAND) [Rvs Orode over Septic Tank tee ;•,' ',."�'' ..' 1. +.. r! .. •a:v •i �•,';:.:.��.: 'ti,t.. 4''+�,:I i.•:r>+ (N SA D) V ',, y� .,:••�,'it,, ,•r �.1'4t.ip•'•}'' `�;M.,.,a•,:+�5 'i..'t.f.yf � ao2 a HOLE TOP OF UNIT ELEVATION - 95.0 ,, a.. r •,;',,:�•. ,� K r: •+.;�.;.;.;::.">, ,r' ;�>.'. "�• '.ti:•� S-0.01 or O eater � �0 DIST. BOX Y Maximum Cover �; 1.4..i.••i 0.4 :V' 'r .• •.�,r•s: ' i r Greater 4'PVC(CAPPED)INSPECTION PORT TO BE '+� ;o a w. 'v�.hr,• t" '":�j ) '' .��•'' 10 EXIS Ot or „a r. + ,ti' ,,': .7 . ,•' .; EXIST P n 1000 GAL s• NEW s. o.ot•P« foot INSTALLED AND TO BE NITHIN a•o►oRADc INV. ELEVATION - 94.50 ::�: ` ;,�; ;,,'.r. .�•,,`,;•:hr;; • ;: �r': .i 1• 1000 GAL 2 PORTS TOTAL j � FROM EXIST. FOUNDATION c SEPTIC TANK .- tV 10' ; '!,,;' ;',A t•h: ;iu' ". U3 W SEPTIC TANK N ta' :: �' I,, • •i+ + f - , �'; GENERAL NOTES CONCRETE FULL) p H-t0 a. .4 o�, BOTTOM ELEVATION - 93.58 b N H-10 n 1. Contractor is responsible for Digsafe notification, Verification of Utilities ee in u > 9 26.00' and protection of all underground utilities and pipes, m e in.of 31e-1 1/2' _ t compacted stone Doe 0f 3/0 4--1 I/2 �' 2. The septic tank a distri .#ion box shall be set 5 MIN ABOVE BOTTOM OF " level on 6 of 3�4 -1 1�2 stone. c C c II 4 ROWS OF 4 UNITS AT e.25'/UNIT+ 2 END CAPS-25.00' 4 8 4 TEST PIT OR GROUND WATER 3. Backfill should be clean sand or gravel with no _ ? E7. WIDTH 12.831 EXISTING SUITABLE MATERIAL stones over 3" in size. e h.af 3 4•-1 1 2" Bottom of Teat Hole 1 Elev,-87.00 4. This system is subject to inspection during installation SYSTEM PROFILE compacted 3l .rani Groundwater Observed - NONE OBSERVED by Carmen E. Shay - Environmental Services, Inc. NOTE: ALL COMPONENTS MUST HAVE RISERS TO WITHIN 8' 80.0W GRADE Not to scale BOTTOM OF TP-1.: 87.00 SOIL ABSORPTION SYSTEM (SECTION) 5. The contractor shall install this system in accordance Observed - NONE OBSERVED HIGH CAPACITY INFILTRATOR (H-20 LOADING)/ GEORGE O'BRIEN with Title V of the Massachusetts state code, the approved plan Groundwater and Local Regulations. (OR EQUIVALENT) NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18" 6, sfoildconditions installation hconditionstthat areor a differenrs t NOTE: EFFECTIVE DEPTH IS 11" from those shown on the soil log or in our design installation must halt & immediate notification be made to Carmen E. Shay - Environmental Services, Inc, - f 7. No vehicle or heavy machinery shall drive over the P ERGO LATI O N TEST septic system unless noted as H-20 septic components. j 8. Install Tuf-Tite gas baffles or equals on all outlet tee ends. Date of Percolation Test: 9/26/11 Test Performed By. CARMEN E. SHAY 9. All Distribution Lines shall be 4" diameter Seh. 40 NSF PVC pipes. Results Witnessed B Donald Desmarais - BARNSTABLE BOH 10. All solid EXCAVATOR: SHAY ENVIRONMENTAL SERVICES, INC. Schedule 401 NSF tees PVC pipes shall water tight djo joints. Percolation Rate: <2 MPI 042" 11. MUNICIPAL WATER IS CONNECTED TO THE SITE and Surrounding -� Test Hole Test Hole Properties. w, No. 1 No. 2 DEPTH -SOILS ELEV DEPTH SOILS ELEV. 0 98.00 0 98.00SAND CB D.H. LOAM LOAMY THE PROPERTY LINES ARE APPROXIMATE AND CB 10 r1t M 10 O M COMPILED FROM THE PLAN BY YANKEE SURVEY COMPANY - ENTITLED "PLAN OF LAND OF #9 STEWARTS AVENUE, DENNIS, MA o'-t2' A 700 0"-12' A �. FOR MRS MARIE GARRISH. DATED JUNE 9, 2010 N 41D 08' 26"E LOAMY LOAMY AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN NEW PL 10 rR e/e 10 red IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 107.42' THE SEPTIC SYSTEM INSTALLATION. 127-42" Be 94.50 12"-42' Be 04.50 1 4' Mod-Coarse Mod-Coone R.83 TEST HOLE #2 Sand Sand PROJECT BENCH MARK TEST HOLE #1 per_ ELEV.- 98.00 2e r 7/4 xa r 7/4 NOTE: ANY FROM THE EXISTING ED OUT LEACH PIT TOOBEAINING DISPOS DISPOSED TOP OF FOUNDATION ELEV.- 98.0o Pape 42"- 132 c, $7.00 42- 13 G 87.00 OF AS PER BOARD OF HEALTH SPECIFICATIONS. ELEV. = 100.00 (Assumed) 9 EXISTING LEACH PIT TO BE PUMPED DRY & 8 FILLED IN PLACE SHED 26' 8.1?' ASSESSORS MAP - 172 PARCEL 137 FAILED LEACH PIT ZONING - RESIDENTIAL ��� D-Sox ,G Perc �It EXISTING Depth. to Perc: 42" to 60 f•REDRi�Oaf `��`�,� i S�'^ Perc Rate- <2 MPI N l IN-CALL `` {` ��0 cgo. (I �� i I Groundwater Not Observed NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY AA RTA(ENT POLYETi•I" NE No Observed E HWT R S R O. Septic Tan� Y- � ADJUSTED H2O Elev. _ None ' u C Enclosed 1000 al. , ALL OUTLET PIPES FROM THE Screen Septic 'Tank ��` `DISTRIBUTION BOX SHALL 4 FL 12" 3 BE HOUSE FLOOR SCHEMATIC DECK Room coNCRETE COVER (Description Provided By Owner) LOT #17 `� i r-r-` _ I . - `X w. ► I ' •`' •t: 8 5• OUTLET . ',�r..•.,• ..,..•. 2• LEGEND KNOCKOUTS I co I -, _ 15s" �' 12' INLET DENOTES PROPOSED .�.. EXISTING OUTLET 8X0 I i i z BEDROOM I s' 8• ,t, SPOT GRADE I I HOUSE LOT #15 Living Bedroom I I w j ;• tss" ' +� ��'�" y • ' • 2 x 104.46 DENOTES EXISTING Room i I t.7s" PLAN-SECTION CROSS SECTION SPOT GRADE PL PROPERTY LINE r------1-1 Kitchen ------ Both ; ; I I , ' 6 HOLE DISTRIBUTION BOX - H 10 PROPOSED CONTOUR Dining I I i % NOT To SCALE 97- - -- - -97 EXISTING CONTOUR Enclosed I I I Design Calculations Screen I ASPHALT I I % DEEP TEST HOLE & DECK Room DRIVEWAY _ __________' ��.�'` Number of Bedrooms: 3 Equivalent to 330 GaL/Day (330 Gal./Day Min. per Title V) 2 BEDROOMS IN MAIN HOUSE AND 1 BEDROOM IN ATTACHED INLAW APARTMENT PERCOLATION TEST LOCATION - Garbage Grinder. No Bath I _ I c2_______---- LOT #16 Leaching Capacity Proposed: 330 Gal,/Day Minimum (Min. Per Title V) FENCE Kitchen �-- Dinin Bath Bedroom _+ r I I f6,666 Square Feet + Septic Tank - 2 x 330 Gal./Day - 660 USE EXISTING 1,000 GALLON TANK AND NEW 1,000 GAL FAMILY Roo g I I �° 98_ r I I Septic Tank for two compartment tank required for In-Law Apartment I 1 I SOIL ABSORPTION AREA: Using percolation rate of <2 min,/Inch PRIVATE DRINKING WATER WELL 100.001 Bottom Area: 0.74 gal/sq. ft. x 473 sq. ft. - 350.02 gallons Sidewoll Area: NOT USED REVISIONS Living Room Bedroom - I m l » N 41 D 13 49 E Providing: 350.02 �ollons --------------------�� I �`- ---------------------------------------------------------------------------- Use: 4 ROWS OF 4- HIGH CAPACITY CHAMBER UNITS WITH NO NO. DATE: DEFINITION --------- - STONE FOR AN SAS HAVING THE DIMENSIONS! 12.83' x 25.0' Bottom Area: (General Use Approval for 4.50 SF/LF of INFITRATOR c� ��R I C R 0.4 L 4 UNITS + 2 END CAPS per ROW - 25.0 FT 4 ROWS x 25.0 x 4.73 SF/LF - 473.00 (40 FOOT RIGHT OF WAY) DESIGN FLOW PROVIDED: 0.74(473 S.F.) 350.02 GPD i i 2-1e'DIAM. ACCESS MANHOLES t-i �.p��• +�i•,t.1}�LyPr��-L ' r:�' b PROPOSED OUT PREPAREDFOR, SUBSURFACE SEWAGE DISPOSAL SYSTEM �, THE ACCESS COVERS FOR THE SEPTIC TANK, �•; DISTRIBUTION BOX AND LEACHING COMPONENT OF .s^�+�s�-*q-.-;r^•.r!-�:Ta-fir';�, r, SET DEEPER THAN a INCHES BELOW nrUSHEO GRADE SHALL BE RAISED TO WITHIN a OF STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE. B A R B A R A A. S W I M M PLAN VIEW INSTALL TUF-TITE GAS BAFFLES OR EQUALS # 12 8 C E D R I C ROAD 3-24• REMavABIdS-� C E N TE RVI LL E, MA I 128 CEDRIC ROAD mh. m2•mol nonce outlet �� - CENTERVILLE, MA 0263�? PREPARE _2r D BY: e•m`, _ A IJ�Tivei- OUTLET : C�1 RM�'N E. SHAY 51 .7' a 0'min. � ,C ` :.a' _,• �1 1 Y E " V-O' min sQ 1^C ,Z� 5 cn +. . L4ub «� 0 20 40 50 4 " ► ENVIRONMENTAL SERVICES, INC. Fda. 11i�1 CE P.O. Box 1576 �. t o 4'-10' CROSS SECTION END-SECTION FciS�,��,� ;� MASHPEE, MA 02649 SCALE: 1"=20' 6ANITa�4 TEL/FAX : 508-539-7966 TYPICAL 1000 GALLON SEPTIC TANK SCALE: 1"=20' DRAWN BY: CES DATE: ASEPT. 26, 2011 NOT TO SCALE PROJECT#SD-1223 FILENAME: SD1223PP,DWG SHEET 1 OF 1 i