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HomeMy WebLinkAbout864 (+862) CRAIGVILLE BEACH ROAD - Health 864 (+862) Craigwille Bea% h Rd Centerville A= 226 - 170 F 1 S M E AD']' No. H163OR UPC 10259 smead.com • Made in USA 2 .y Commonwealth-of Massachusetts. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspectdrr Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 Cityrrown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Eval�in he Local Approving Authority 8-8-15 fRIS—ector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t'.0 �s t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage ystem sposal -Page 1 of 17 v Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): i t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 I , Commonwealth of Massachusetts . = W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system,is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool'or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. w 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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"non to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system.inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2015 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped 2015 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? 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) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts TM Title 5 Official Inspection Form VL a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"tank 1----22"tank 2 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 14"tank 1---14"tank 2 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: 2-1500's Sludge depth: 6" both t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts " Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 26" both Scum thickness 1" both Distance from top of scum to top of outlet tee or baffle 6" both Distance from bottom of scum to bottom of outlet tee or baffle 15" both How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both tanks in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t t5ins•3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 0 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): . Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 „ , Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good conition with water at working level and no sign of back-up from field. 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.): Pump chamber in good condition with pump and alarm tested to be in good working order. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-15x40x6 ❑ 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.): Leach field in good working order with no sign of back-up into d-box or surrounding stone. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-W 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �ra a _a "7 r SDI- Y O �•�� � D-6• - . �. F �. *2` 33•5 '' E `7- 13 t5ins•3/13., Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage.Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 70" 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: Original design plans show groundwater at 70". System was raised to accommodate high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Shalimar Properties Owner Owner's Name information is required for every Centerville MA 02632 8-8-15 page. City(rown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 o s y a 1- a o a i9- - as' F-7-33'F" E-7- ' -- TOWN OF BARNSTABL E LOC. TiQN �,a6 5� i a,Vic/M�6e : o S—WAGE # VII.L AGE C� 'i'y/?/�e ASSF, SC}RS MAP&LOT— SEPTIC TANK CAPAGITX 1.�ACFIING'1~ACII;1?€'� ftyp") n/ {sized pd- NO.OF-13EDRQQMS_ BUILDER OR OWNER PERITDATE CQMFLIANC DATIw Separation Distance.Between.the Maximum Adjusted.GroundwaterTabletsthe:Bottam'aUkhtngFacility Feet - PrivateWater Supply, eii sad Leaching (If arty woIls exist un site yr within 200 feet'of leaching faciBity) t Edge of Wetland and LeacWng Faeiuty�y wetlands e within 300 feet of leaching facility) Furnished by: i Commonwealth of Massachusetts j Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville. MA 02632 6-24-13 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. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: Shawn Mcelroy / �J Name of Inspector Upper Cape Septic Services Company Name P.O. Box 73 Company Address E. Falmouth MA 02536 CitylTown State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant JF ection ' 340(V Title 5 (310 CMR 15.000).The system: c._ '.-.q O ® Passes ❑ Conditionally Passes ❑ F�'ail - c� ❑ Needs Furth Ev a io the Local Approving Authority s.a 6-24-13 M ,� m Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection urface Sewage Disposal System•Page 1 of 17 L a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ one or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for es", "no"or"not determined" "y (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. c *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Z Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) j ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspectionform:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form m Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system asses if the well water analysis, performed at a DEP certified laboratory, for fecal Y P Y , P rY, coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/Z day flow t5ins•3M 3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 9 p Y ry ,M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 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 ❑ El, Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments G M , 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 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)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M s 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 6-2013 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �,M 5 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"tank 1--22"tank 2 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.): Good condition. Septic Tank(locate on site plan): Depth below grade: 14"tank 1--14"tank 2 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: 1500 gal--both Sludge depth: 12"--both t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 20"--both Scum thickness 1"--both Distance from top of scum to top of outlet tee or baffle 6"--both Distance from bottom of scum to bottom of outlet tee or baffle 16"--both How were dimensions determined? Tape Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Both tanks in good condition with baffles installed and no sign of leakage. Both tanks have Zabel filters installed on outlet ends of the tank. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-W3 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): i *Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M s 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up from field. 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.): Pump chamber in good condition with pump and alarm tested and found to be in working order. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts N F Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-15'x40'x6" ❑ 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.): Leach field in good condition with no sign of back-up into d-box or surrounding stone. 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 15ir s•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs'of hydraulic failure, level of ponding, condition of vegetation, etc.): } t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately F � a .�. - 6-3 r t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 70"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: Original design plans show groundwater encountered at 70" Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 862-864 Craigville Beach Rd Property Address Linda Auerbach Owner Owner's Name information is required for every Centerville MA 02632 6-24-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 G TOWN OF BARNSTABL,E LOCATION o 'YX i v t I �C AK WAGE VILLAG Lv� eru (e. ASSESSOR'S MAP& LOT- - INSTALLER.'S NAME&PHONE NO. ` SEPTIC TANK CAPACITY LEACHING FACIL17T., (type) �� �d (size).,,,`S X X(o NO.mF'Bl~DROOMS.._.q_..._..� .. BUILDER OR OWNER PERMIT®ATE: „__.. COWILWICE DATE: Separation Distance Eetvreq the: Maximum Ad}ustul Groundwater Table to the Bottom of Leaching Pacility Private Water Supply Well and Leaching Facility (If any wells exist on site or within 2M feet of leaching facility) � !`Fact Edge of Wetland and Leaching Facility(if any wetlands exist within i0 fret fleac:hingfacility) Furnished by e `�.4mv � _- . P.G -a-alb s f Commonwealth of Massachusetts Title 5 Official InspecUon Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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. A. General Information 1. Inspector: �II� Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E..Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection._The inspection was performed based on my training and experience in the proper function and maintenarc of orAite sewage disposal systems. I am a DEP approved system inspector pursuant to�Sectionlj.3409of Title 5 (310 CMR 15.000).The system: s ® Passes ❑, Conditionally Passes ❑ Fair. C) ❑ Needs Further valu on by the Local Approving Authority CIO 10-28-08 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. '.***This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Electricity was off and was not able to check pump and alarm. 1v71 15insp•03l08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °wM •''� 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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: System is in good working order with no sign of failure. 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. I ❑ 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 t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 r Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 862-864 Craigville Beach Rd - Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): , ❑ 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: 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. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 15 Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary.Assessments wM 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services r Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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 asses if the well water analysis, performed at a DEP certified laboratory, for coliform Y P Y , P rY, bacteria Indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 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 wate r supply. t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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 C.MR 15.304. The system owner should contact the appropriate regional office of the Department. t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts u W Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form -Not for Voluntary Assessments qM 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 every page. City/Town State Zip Code Date of Inspection C. Checklist ec st 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? ® ElWere 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 ® ❑ tY ( P ) 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-03/08 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 ^M 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x #of bedrooms): 440 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: 8-08 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CM 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): t5insp-03108 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 M 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Not pumped since installed in 2006 Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: 2006 Were sewage odors detected when arriving at the site? ❑ Yes ® No t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigviile Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 16"tank 1--14"tank 2 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.): Good condition. Septic Tank(locate on site plan): , Depth below grade: 10"tank 1--8"tank 2 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: 1500 Gal--both Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle 26" Scum thickness 0 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 16" How were dimensions determined? Tape t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts - 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G1M 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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.): Both tanks in good condition with baffles installed. 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): t5insp-03/08 Trtie 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is Centerville MA 0202 10-28-08 required for 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 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ® No Alarms in working order: ❑ Yes ® No t5insp•03/08 Tdle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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.): Pumped chamber was filled with water because electricity was off. Not able to check pump and alarm. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-15'x40'x6" ❑ 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.): Leach field in good condition with no sign of back-up in surrounding stone. t5insp-03/08 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 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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.): t5insp-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name information is required for Centerville MA 02632 10-28-08 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. tr} r /� .f 0 o 9 tw3 Ci q 3 7 C-3`.2*' C-`/-P3" t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 15 Commonwealth of.Massachusetts Title 5 Official Inspection, Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 862-864 Craigville Beach Rd Property Address Saxon Mortgage Services Owner Owner's Name „ information is required for Centerville MA 02632 10-28-08 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 high ground water: 70"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: Original design plans show groundwater at 70". t5insp•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 �,(_t' ; ✓ .`o.'.,�yt+�ntr"rv;d.wwh,.,.w.:.,•pr:.»,roa�,nd..... . i r. . ....-,.-. ...._..:..-.'./'.� �_.. y. a ......:-.r.ry-- .. •.......-:a r.r.{ - - _. .y ,.cam r...rcr^.^ti...+r •./•I•.' ..- -- _ TOWN OF BARNSTABLE BAR-W 5947 Ordinance or Regulation 16 WARNING NOTICE Name of OffenderMa-nage-r-, '"' . ,- r­cAn dob (irA 41 Address of Offender ( (" � �,1� c9Z r MV/MB Reg.# Village/State/Zip r _ Business Name t7 aII/pm, on <K N 20n' Business Address __ k Signa`tuie of -tnforcing-Officer Village/State/Zip {{ Location of Offense Enforcing Dept%Division Offense Facts t r, �-A � .4 'k", ,Nc k N'Y*.t (\a 'A- rtx ► 'z� c rk 11'Cr I& C J41)C,o V) ( g V 0 lc& ri This will serve only as a warning At this time no legal action has been taken. ': It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. �, Citizen Web Request Page 1 of 1 t �N /%/is �% FEE Citizen Request Management r,yY; Request ID: 22044 Created: 8/4/2008 10:22:42 AM Status: Closed Assigned To: Desmarais, Donald . . Health Office Anonymous: Yes Category: Section 353-1 Garbage and Rubbish waim ,,N E.C. Date: 8/6/2008 Created By: Couto, Melissa Citations: Health Office Time Worked: 1.00 Response Time: 1.00 Request Location: Charles Marshall 864 CRAIGVILLE BEACH ROAD Centerville, Ma 02632 Parcel Number: Map: 226 Block: 170 Lot: 000 Request: JUNK ALL OVER YARD. BELIEVES IT TO BE A POSSIBLE HARBORAGE FOR RODENTS. Request Work History: Entered on 8/4/2008 1:21:44 PM Last modified on 8/4/2008 1:22:21 PM DD went and saw multiple trash violations. Spoke with Charles Marshall and told him he needed to clean up the cardboard and plastic. He said he would have it done within two days. A warning was sent out. I also urged him to tidy up the building materials. Attached are photos of the property. Will monitor. http://issgl2/IntemalWRS/WRequestPrintPub.aspx?ID=22044 8/4/2008 r 4 4 , _.. a pp j . F a _ z t •ii 'b i F vEms-q, •.x ty a...�4�.�ta a, 1 r A � �, > .� `' < , �: � �_ Sri\�'� '- _ _ � _ I � _ _ r 4 � - ._ -. .. — - — � y/ �F° � � � � d. �,` w ,, �' .� ! 9 a L Z m t� i 3 A_ 4 _ �' _ y\. i '�:- � �`+ t ti � � �; � F.� s r�, _, i� � � ��a�} ��ii �}- 7 y � � �' t �� {T �� ���, ��'' / �� i�\ , �J� ti, ` �\ � Rr / f t1i, � . _ e II ._ •� lk :53:� � -y"J�t',-,� •" � �/� °"..+ Tl: t!� °''+"mar,.1.:, f ��.4 r f. a. . 5�',w,�r♦s a�`F^`!° 9`�,. �r��'�F�+3^-, t AI�, ..�p` a l: •�%r '7.� ��• y�;pr . 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R�y,'',`�. �--� ���1 /flu'' ' � � a�� .�• �'�M1� _, 1 Cg ,.�;�'� �� ;. i . b � � '� f � � ���F ti �� ,�;�t ��1� � - .:� 1'—_ � t / Y �ii r ♦, _ �t� '14,''`��:� J ,. 2` �. _f � _Y _ � �, Town of Barnstable ��"'E'1D •� Regulatory Services } Thomas F.Geiler,Director - BAR.\5?ABLE. Ass Public Health Division •63q. �� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: 1 5- o 2 Sewage Permit# Assessor's Map\Parcel ;2;L� l O A,N �L J ri tFr�r n.•/ Designer: � S Installer: . '60 j G- Address: B I , P o Y. 1531 Address: ®< boy- �S`t'�iw�«(� /''l/� 0�65� ��T�n-•�r�trf I't� ®..z-6�,� .. On AW!/l0 G e Seta e,• was issued a permit to install a (date) (installer) septic system at obi/OoN 0t,,wi-vi L-+-E f eA44- based on a design drawn by (address) dated fl 19 ZD 6 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. �I I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State &Local Regulations. Plan revision or certified as-built by designer to follow. f (Ins ler s Signature) Gs (Designer' Signature) (Affix Desigriei's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 3-26.04.doc m ac 21596 P:9 83 076727 { DEED RESTRICT �1V j �'�e-�6 3 e r i WHEREAS, Max Schertzer and Pearl Schertzer, husband and wife as tenants by the entirety of 85A Seminary Ave., #149, Auburndale, MA 02466 are the owners of 862-864 Craigville Beach Rd., Centerville (Barnstable), MA being the land in Barnstable (Craigville), Barnstable County, Massachusetts, being shown, as LOT 14 on a plan of land entitles "Subdivision of Land in "Craigville" —Barnstable, Mass. Property of Louis H. Bowmar. Scale 1"= 40'. October 20, 1949, Bearse & Kellogg — Civil Engineers — Centerville — Cape Cod," which said plan is duly recorded with the Barnstable Registry of Deeds in Plan Book 92 Page 135, to which Plan reference is hereby made for a more particular description of said lot, which lot is hereinafter sometimes referred to as the "862— 864 Craigville Beach Road premises". WHEREAS, Max Schertzer and Pearl Schertzer as the owners of said 862 — 864 Craigville Beach Road premises have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a re-condition to obtaining disposal works p g a p construction p ermit in compliance with h 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage. WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit fo r a septic system in p p p y compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document. NOW, THEREFORE, Max Schertzer and Pearl Schertzer do hereby place the following restriction on this above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 862 — 864 Craigville Beach Road, Centerville (Barnstable), MA may have constructed upon the lot a house containing no more than four (4) bedrooms. Max Schertzer and Pearl Schertzer agree that this shall be a permanent deed restriction affecting said 862—864 Craigville Beach Road premises. For Our Title see Deed at Barnstable Registry of Deeds dated April 6, 1983 recorded in Book 3709 Page 181. Executed as a sealed instrument the 8`" day of December, 2006. Max chertzer Pearl Schertz&' '_ i 1 November 14, 2006 To: Town of Barnstable Board of Health Re: Septic System upgrade at 862/864 Craigville Beach Rd., Centerville, MA We authorize Douglas A. Brown and Daniel Johnson to represent us for the request for variances at 862/864 Craigville Beach Rd., Centerville, MA. r Signature. Max Schertzer Pearl Schertzer -� ( J S V 8 0 tj ` _ O V a 00 LLI x O t IA - >< f - - �t DATE% r r aKAM .BBC. 8Y_ ` Town of Barnstable 9CMD. DATE:, obAoc� Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Susan G.Rask R.S. FAX: 508•790-6304 Summer Kaufinatt.M.SP.H. Wayne A.Miller.M.D. ,4 VARIANCE REQUEST FORM LOCATION Property Address: e 64�G-1 61LAt e/vi LLi5 ���4G/,< /�-�� 6 e rLrc� Assessor's Map and Parcel dumber: 2;-6 l 17 O Size of Lot: 6 Wetlands Within 300 Ft. Yes Business Name: No �� Subdivision Name: APPLICANT'S NAME: N /t L J+�l�n1f`� Phone �7 o° q7? 99 c Did the ovi=of the property authorize you to represent him or her? Yes L No PROPERTY OWNER'S NA1NIE CONTACT PERSON �2TL�/� Name: /v1fF S/If c�'ame• CC J Address: 6 4 C a sic��`� -� t,4e� iz0 Address: to O, 3 0 1, `Z.s U S retry t LL1r Phone: b l?� 3 32 - 6310 a Phonc:_ S. 9.9 0,9 T VARIANCE FROM REGULATION lust xes.) REASON FOR VARIANCE(May attach if more space needed) is � ir<tsD /.yS��FiC/Ent oPL'� SP4C� O/~t P2ofCTeCTY /h�CT TITLE V SC T Bi}CK �Q✓t 2�M E.y'TI G .,tin I NATURE OF V�'ORIC: House Addition ❑'E❑❑0 House Renovation ❑ Repair of Failed Sep c System yam' heekl (to be completed by office staff—person recerAng variance request applicationj 1 Four(4)copies of the completed vesiune,request form W Four(4)copies of engineered plan submitted(e.&septic system plans) Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) _ _ Signed letter stating thu the property owner authorized you to represent hin✓her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting late applicant'�pensc . (for Title V and/or local sewage regulation variances only) C:) r— _ Fun menu submitted(for grease trap variance requests only) %.0 _ VarianZe request application fee collected (no fee for lifeguard modification renewals, grease trap varian a renewals (same owncrAmee only],outside dining variance renewals(same ownerlleasee only].and variances to repair failed sews. disposal syste:rts (only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Risk.RS.•Chairman NOT APPROVED Sucsma Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A bolter.M.D.Q:\XEALTH\WPFZLES\VARI?=.DOC f VARIANCE: VIA LOCAL UPGRADE APPROVAL 1 . Request variance to reduce the offset of the proposed leaching area to the property line from 10 feet to 5 feet, 310 CMR 15.405 (1) (a) . 2. Request variance to reduce the offset of the proposed septic tank and pump chamber to the property line- from 10 feet to 7 feet, 310 CMR 15 . 405 (l) (a) . 3 . Request variance to reduce the offset of the proposed leaching area to the foundation wall (crawl space) from 10 feet to 5 feet, 310 CMR 15. 405 (1) (b) . 4 . Request varaance to reduce the offset of the proposed septic tank and pump chamber to the foundation Wa7 (Cr,=w1 svaC?) from 10 feet to 5 feet, 310 CMR 15 .405 ( 1) (b) f Of SHE TOE t Town of Barnstable BARNS'CABLE. ` 9� MASS. &639. Board of Health ♦� Ar fD MA'S A. 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. January 10, 2007 Mr. Daniel Johnson, R.S. P.O. Box 831 Osterville, MA RE: 862/864 Craigville Beach Road, Centerville A= 226-170 Dear Mr. Johnson, You are granted conditional variances on behalf of your client, Max Shertzer, to construct an onsite sewage disposal system at 862/864 Craigville Beach Road, Centerville. The variances granted are as follows: 310 CMR 15.405 (1)(a): The leaching facility will be five (5) feet away from the property line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.405 (1)(a): The septic tank and pump chamber will be seven (7) feet away from the property line, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.405 (10) (b): The leaching facility will be five (5) feet away from the crawl space of the dwelling, in lieu of the ten (10) feet minimum separation distance required. 310 CMR 15.405 (1)(b): The septic tank and pump chamber will be five (5) feet away from the house (crawl space), in lieu of the ten (10) feet minimum separation distance required. These variances are granted with the following conditions: (1) No more than four (4) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and JohnsonSchertzer862Craigvi I le t similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to four (4) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) No additions are authorized as there shall be no increase in footprint to the foundation or increase in elevation of the building in the future. (4) The septic system shall be installed in strict accordance with the design plans dated November 9, 2006. (5) The registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the plans dated November 9, 2006. These variances are granted because the physical constraints at the site severely restrict the location of the soil absorption system due to the small size of the lot, of only 6,410 square feet. It is the opinion of this Board that the proposed new soil absorption system is designed to meet the maximum feasible compliance standards contained within the State Environmental Code, Title V. S' rely yours Waynb A. Miller, M.D. Chairman JohnsonSchertzerMCraigville Postal CERTIFIED MAILT,, RECEIPT �- (Domestic Only; For delivery information visill our website at www.usps.corrtt, m %UFKP'r'C m $0.39 Postage $ C:1 O O GertMed Fee $2.40 A �j O O Return Receipt Fee $0.00 � (Endorsement Required) O Restrlded De"very Fee �& -0 (Endorsement Required) $0.00 sS / ra Total Postage&Fees $ $2.79 H/ 9 d Ln O nt o N Lou/f -G4Tff��/elir �gcc/1'2� - ----- ----- --------•- - - - -or PO Box No.o .Z-7 i ,r ,.1�nr 24oUC crh.5mte,ZIPw aA j /-4 (on>O PS Form 3800.June 2002 Certified Mail Provides: (evemu)zoo£eunr'009£LodSd ■ A mailing receipt I ■ A unique identifier for your mailpiece ' ■ A record of delivery kept by the Postal Service for two years Important Reminders: ;. ,.,: , , ■ Certified Mail may ONLY be combined with First=Class Mail®or Priority Maile. ■ Certified-Mail is not available for any class of international mall. ■ NO,INSURANCE COVERAGE4IS'f'ROVIDED with Certified Mail. 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Internet access to delivery Information is not available on mail addressed to APOs and FPOs. 0 I \ 1 cUedc ad } i opt DAB: rest 0 Town of Barnstable SCCMD. DAM: �1Q(p Board of Health rr 3 200 Main Street,Hyannis MA 02601 Office: 508-862-4W Susan O.Rask,R.S. FAX: 508.790-6304 Sumner Kauftnan..M.SP.H. Wayne A.Milks.M.D. VARIANCE REQUEST FORM LOCATION Property Address: e 64 96 Assessor's Map and Parcel Ntimber. � l Size of Lot: 6[ � �0 Sea- Wetlands Witham 300 Ft. Yes Business Name: No 7— Subdivision Name: i a APPLICANT'S NAME: D41V 1,67L & J D thVj 44 Phone (5ob) .17?-g9 O 9 Did the owner of the property authorize you to represent hum or her? Yes )I-- No i 3 PROPERTY OWNER'S NAIYIE CONTACT PERSON Name: /✓� Name: he"I e'd- J a trf N S 0.-1 i Address: �ti 4 C'�'}c 6 l`-� g e .zD Address: /O, Phone: Phone: �,) 33� 6 3 8 D 3'� 99 e9 4 q?� i VARIANCE FRONT REGULATION(L'at Iteg.) REASON FOR VARIANCE(May attach if[note space needed �Gs �1tc.��/� /�ys�FpK/E�% DPt'n[ SP•¢C� F 0(" l2 ci°[TAT X Yet /"\CZ:T TITLE V SET &#C-K XZQ,;[2�M enl T f NATURE OF WORK: House Addition CI�❑❑❑ House Renovation ❑ Repair of Failed Septic System I ra hickC t(to be completed by office staff-person receiving variance request application) _ Four(4)copies of the completed variance request form mar' _ Four(4)copies of engineered plan subtnined(e.g septic system plans) a _ Four(4)copies of labeled dimensional floor plans subn-dited(e.g.house plans or tesrnurant kitchen plans) Or _ Signed letter stating that the property owner authorised you to represent him/tter for this request ; Applicant understands that the abutters trust be notified by certified mail at least ten days ptor to meeting iate� licant's c4l'inse 3 (for Title V and/or local sewage regulation variances only) _ Fun menu submitted(for grease trap variance requests only) _ Varianze tequect application fee collected (no fee for lifeguard mod fication renewals, grease trap v n renewals 'same owner/leucc:only],outside dating variance renewals(same owner/leasee only],and variances to RTaif failt4 sewa disposal SQ. CT (only if no expansion to the building pmposedl) M _ Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Susan G.Risk.RS., irman NOT APPROVED Summer Kaufman,M.S.P.H. REASON FOR DISAPPROVAL Wayne A.Duller.M.D. Q:\KEALTH\WPFILES\VARIM-DOC i VARIANCE: VIA LOCAL UPGRA13E APPROVAL 1 . Request variance to reduce the offset of the proposed leaching area to the property line from 10 feet to 5 feet, 310 CMR 15. 405 (1) (a) . 2. Request variance to reduce the offset of the proposed septic tank and pump chamber to the property line, from 10 feet to 7 feet, 310 CMR 15 . 405 (1) (a) . 3 . Request variance to reduce the offset the proposed leaching area to the foundation wall (crawl space) from 10 feet to 5 feet, 310 CMR 15. 405 ( i b) . 4 . Request varaince to reduce the off=set of the Proposed septic tank and pump chamber to the foundaLio 'N n Q_i (crawl space) from 10 feet to 5 feet, 310 CMR 15 .405 ( 1) (b) i i November 14, 2006 To: Town of Barnstable Board of Health Re: Septic System upgrade at 862/864 Craigville Beach Rd., Centerville, MA We authorize Douglas A. Brown and Daniel Johnson to represent us for the request for P q variances at 862/864 Craigville Beach Rd., Centerville, MA. Signature Max Schertzer Pearl Schertzer DEC-06-2006 09 :27 PM DANIEL JOHNSON 508 420 9316 P. 01 f' DOMESTIC SEPTIC DESIGN, INC. F.0. Box 831 062=VXZZX, MR 02655 IZZ/FAX: (508) 477-9909 DAN=Z B. JOl' MCW, R.S. , C.8.E. FAX'CCVZR LETTER Name : Tom McKean Company: Barnstable Board of Health Reference : 862/864 Craigville Beach Road (Buoyancy Calc' s) Date: 12/6/06 Fax Number: (508) 790-6304 Sent By: Daniel B. Johnson Message: Attached are the buoyancy calculations for the proposed 1000 gallon pump chamber and 1500 gallon septic tank for the septic system at the above referenced site. (FYI : I did not submit these calculations at the time of the septic design submittal like I told you at yesterdays Board of Health meeting, I apologize for this error. ) If you have any questions, please do not hesitate to call. DEC-06-2006 09 :27 PM DANIEL JOHNSON 508 420 9316 P. 02 i BUOYANCY CALCULATIONS FORMAT PropertyLocatioa: a6.2-1 S69 cR-4lbv-L" Property Owner: AiA� S N CA Z CA Date of Submittal: /.t/d(0 6 COMPONENT: SEeriC r*,*Q K SIZE: ISS00 Gallons Constants: Weight of Concrete @ 150 Lb/CF Weight of Water @ 62.4 WCF Weight of Fill (Dry)@ 100 Lb/CF PROFILE-OF TANK Finished Grade C4. ��O 141 slit Top of Tank.EL: 717 $ Gronnd Water Ed.: 2- 8 Bottom of Tank El.: 60 Weight of Tank: A 1,.Z 3 c 16 �S�Rsv sP�cs� Weight of Fill over Tank: � //I * � A /S° /11 Weight of Water Displaced. Total Downward Force(wv*%of Tank+Weight of Fill): DEC-06-2006 09 :28 PM DANIEL JOHNSON 508 420 9316 P. 03 BUOYANCY CALCULATIONS FORMAT Property Location: 463,1844 Property Owner: OAf S+1 EST s 6R Date of Submittal: COMPONENT: PIMP c*"sE- SIZE: j000 Gallons Constants: Weight of Concrete® 150 Lb/CF Weight of Water @ Q4 Lb/CF Weight of Fill(Dry)® 100 Lb/CF PROFME 4OF TANK Finished Grade 66'1 811 Top of Tank El. :71 �, S Ground Water El.: X a 1 b� Bottom of Tank El.: o ,i S �I W*.ht*f Tank: Weight of Fill over Tank: 0"4 0 ri'" �,94�N� w iso lhIcf : 31 61916 Weight of Water Displaced: 9'� S�1�w ��S9 r 6; ,9 /6 A00 : 6, 9 8 0l b Total Downward Force (w,*ht of Tmk+w*ht of rill): G r B v 00 C LA •, 1 NO. yc n•.^: .r Fee `THE COMMONWEALTH OF MASSACHUSE Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for �Dtgpo$AY *pztem Cott!6trurtton Vermtt Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 60 ZY 6kw, Bme l Owrier's Name,Address,and Tel.No. Assessor's Map/Parcel 70 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 1as A508-.`/Cb-9/ tC S�otic �ps�b N Type of Building: Dwelling No.of Bedrooms L1 Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building�PQ rx No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 2-1 SMCkel'elnf l Oecj /SIN&pe of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) It,) \, we U) septic S!tf.+e0%-_ Date last inspected: Agreement: The und&signed 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 beemissued by thi of He th. S' ned Date /2 / QC Application Approved Date J Application Disapproved by: Date for the following reasons Permit No. azo rP o��� Date Issued �„ r • ;,, .. —,,,ter—�-+ � �.- b...-.,,,s,� .. .0-. y-•.,. ... Fee Entered in computer: TH E•COMMONWEALTH OF MASSACHUSE- - p _ PUBLIC HEALTH.DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Yication for dig ogal �b gtem Corigtructioft Permit z a.,rApplication for a Permit to Construct Repair Upgrade Abandon O ❑ Complete System ❑Individual Components Location Address or Lot No. 66 ./ ��r!/G�5 P /3���`j � Owner's Name,Address,and Tel.No. �� C•R��Prv, l�`P /1/Ir.�kkX Sht�rt �cr� r- Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. s ro,u'D 5-OS- /Q7-7/Sy Uc .+�< <6 �t 1� `�� S ��. , v T3UX. ��/s Fv+Pr 1`to 1��. SU - °-177- 9 C ` `Type of Building: Dwelling No.of Bedrooms Ll Lot Size sq.ft. Garbage Grinder Other Type of Building'�y}p}P x No.of Persons Showers( ) Cafeteria,( Other Fixtures " Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank a-lL-IM 1 el w t +h 1S+ lsype of S.A.S. Description of Soil M. +Nature of Repairs or Alterations(Answer when applicable) ���,i c,�� Ale,U S f- i C e+PN,,- Date last inspected: s 'Agreement: 1• 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 thi Board of He lth. Signed. _ _. Date 11 r// �j C Application Approved Date J f j Application Disapproved by: Date for the following reasons Permit No. (D `lr Date Issuedfo 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 , oS A T�, r) n3 at q[a c yi ��j r (",vr j+r r� P has been constructed in accordance /►1' with the provisions of Title 5 and the for Disposal System Construction Permit No. ��J. c�6 �"',�0'"'1 dated t ) 6. Installer._I_,/��,\kyf s tF (ov j N) Designer—_k�)raN tom` 7A, "rc,"i J #bedrooms 44 Approved design flow 46 gpd The issuance of this permit shall not be construed as a guarantee that the system will_funct•o -as1 igned- Date Inspector ---------------------------------------------- No. Oco � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS xigpogal *pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Aba don ( ) System located at 6Ga A6 ��u �s��/�,� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Con`sttructio `must be completed within three years of the date o t'ape it. Date /� ApproveLy,_ - a J TOWN OF BARNSTABLE - LOCATION CrC1 SEWAGE # "—Sc2 L .VILLAGE r e to ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.. R. famr,� SEPTIC TANK CAPACITY a-I,SC O 8CJCq 0,C.,S LEACHING FACILITY: (type) - (size) NO. OF BEDROOMS BUILDER OR OWNER OWtlor PERMITDATE: 1 COMPLIANCE DATE: 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 faaicility) , , Feet Furnished by `�Im c�ccl�r� t11cf6 he lc_ s_� Ste_ 7 -9�Dy r o i � UI . Is t� F1-17CI--'UC3n-11 :B3—.-e A.5--15�Ds-16c '7-- -D8-3.9 E cl-23 1-13 10•-37 7 t �TME Town of Barnstable P# Departinent.of Regulatory Services J q Public Health Division Date �/ 46 i63y 200 Main StreetTyannis MA 02601 FO Mid t'� �-' I Date Scheduled ���� Time Fee Pd. Soil Suitability Assessment for Sewage Dis os Performed By: Ij�tN LsL- B, D t`t/IlS O Witnessed By: LOCATION& GENERAL INFORMATION Location Address ' c ` Owner's Name c r� Address �� J 22.C, /7b_ Assessor's Map/Parcel: Engineer's Name 'Q)C-;,3 NEW CONSTRUCTION REPAIR Telephone# 150S_-y77.. Land Use E,9C-,471.4 L Slopes(%) it C Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands?n proximity to holes) A / A 1. R0_ao ads a Ar DtsGh w `'SancSET G�nt� � � w —a Parent material(geologic) �`�'t N,e}S Depth to Bedrock N 44 rr f O r p rn Depth to Groundwater. Standing Water in Hole::_+ 7 .: Weeping from Pit Face E'J Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: __ _ in, 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.Orouttdwater Level,,,, PERCOLATION TEST Date`o. ®6 nme o a c_ Observation 77-1 "Time at 4 Hole# -- --�- rr P Depth of Perc 36 Time at 6" Start Pre-soak Time @ /a,O6 _ 'lime(9"4") End Pre-soak /O 'l6 Rate MinJlnch L�MQS �✓r�ut� Nam fto�� �4 (,4L, I1A-&f041 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 Conseirvation Division at least one(1)week prior to beginning. Q:\SEPTICVERCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. istenGravel) t R-.7 �6 r� q44 c/ N►�C°s 57 �na6:1L9��t -_DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% jj l v A. !°Y/-312 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA). (Munsell) Mottling (Structure,Stones,Boulders. C i toGravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) '`(USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, i Flood Insurance Rate Map: 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 pervious material exist in all areas observed throughout the area proposed for the soil absorption system? es If not,what is the depth of naturally occurring pervious material? .._. Certification I certify that on 1119,( (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required train' a pertise a d experience described in 310 CMR 15.017. Signature Date i d � O b Q:\SEP.TlC�PERCFORM.DOC TOWN OF BARNSTABLE BAR-w 5947 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager# (_�rrjrCT r 1 Address of Offender ?(r I (e%_1_1kVM11r' MV/MB Reg.# Village/State/Zip k 1c, k lip ,) I tA Business Name aim/pm, on 2 0= Business Address Signature "-of Enforcing Officer Village/State/Zip Location of Offense )C-. CA Enforcing Dept/Divisidn Offense 7 Facts -A k­�t Lt iL C kJv�l­o-. LR C 4- 'b r V(� This will serve only as a warning."-At-this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 1 , :f f M, xYy� 1 r r \. y / 1 lolF / b G- , i 4 �' ilia f a s b rq aH aF f f. . a r i a � s .w Y 1 3 � IN, t� oll NP � 8 i 1 bps ���: '1�,� �... �l➢ Y ! /r;. ,� " 6 - 7 3 z � , 1 i pp f� n Az- / } / r IN 41 «� a r, y v-F 9 t u" gg ✓e o / h I�III � s ,v / ro f Y d I ,r i 'r rr/✓a ;a J s A r Too WWI el fir S��y�+v.'„go'.' C 3��F�jJ�' ,•, 3 a him �� / r I Ycf' /r h J •i r �� .kef• /c" .,H,.aya,„ ,.�.,,_ .�/ti / �yi�Ja33, 'r .'� Page 8 of 8 F. Daniel Johnson representing Max Shertzer, 862/864 Craigville Beach Rd, Centerville, 6,400 square feet lot, repair of failed septic system, variances to setbacks. Dan Johnson understands the inspector failed it due to ground water interference. Soil tests were done. This is a duplex. Two bedrooms in each duplex. It is a single ownership A monitoring well was put in. Very little change in water. Leaching area is in NW corner will very little room. Existing septic maintained. Two septic tanks. Propose upgrade one of two septic tanks so both will be 1500 gallons. Which will flow by gravity to a 1000 gallon pump chamber (same chamber used for both) Variances needed for setbacks to property lines. Dr. Canniff asked distance of wall from property line. Answer: only 2 feet. TM said how can we fit plantings? Dan said there will be the stone wall which is pleasing to look at. Staff had a couple questions: bouyance amount?, do you show a new liner used? The alarms would be set on the outside so that if the owner is not home, the occupants of the other side of duplex will be able to hear it. Dan believes it is hundreds of feet to the water. Dr. Canniff thinks it is must closer than that. Dr. Miller feels it is a good plan. There will be a four bedroom limitation. Charles Marshall spoke as a potential buyer, who would be be increased in making a dormer due to low ceiling. Motion made BOH can stipulate No change in footprint or elevation, no increase in bedrooms, no increase in flow.. With a 4 bedroom Deed Restriction. Voted approved. G. Darren Meyer, Septic System Designs, representing Sarah and Jim Hermitage, 54 Nye's Neck Road, Centerville, 18,100 square feet lot, house addition, repair of failed septic system, four variances. Edward Stone, Land Surveyor, represented the owner. (Darren Meyer could not make it). The house is 626 existing. Proposing 864 sf house. (about 33% increase) Staff comments: several issues: applicant suggesting One Bdrm Deed Restriction thus requires DEP approval. Didn't like closeness of well. No reserve area and . (Dr. Miller said for a failure a reserve area is not required) Staff recommends denial No. r ' Fee S THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS Zlpprication for Migo!ml 6potem Congtrurtion Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) CL� omplete System O Individual Components Location Address or Lot No. Owner's Name Address and Tel.No. Assessor's Map/Parcel a G 7CWrtAA Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 144C#44�iv? 7' '? 7 5-! 3 e 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 Nature of Repairs or Alterations(Answer when applicable) /� l..S- � / V C, 'Xi il.A Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been is y this Board of Health. _ Signed Date Application Approved by Date Application Disapproved for the ollowing reasons Permit No._g�' ^ fjv`oZ.� Date Issued W rl� lyo. f Fee / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLES MASSACHUSETTS 01pprication for Migonl *p!5tem Conotruction Permit Application for a Permit to Construct( )Repair( )Upgrade( Abandon( ) LfTComplete System ❑Individual Components Location Address or Lot No. ,(} Owner's Name Address and Tel.No. Assessor's Map/Parcel /7/ Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 14d<' H1Z5ev3' 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 Nature of Repairs or Alterations(Answer when applicable) 1, / / / y d S % Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued- y this Board of Health. Signed__� o ��j-r Date ",5; Application Approved by i' Date Application Disapproved for the ollowin easons Permit No._T Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS i,a y (Certificate of Compliance ` THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( ),Repaired ( )Upgraded( ) Abandoned( )by 12 c at S IrA 11 v i,/e / t.g C /a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer Designer The issuance of this permit shall not beconstrued as a guarantee that the system ill function as designed. Date O 1 Inspector_ Q No. Fee _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mwi5poar *p�tem Construction Permit Permission is hereby granted to Construct( 'Repair(r )Upgrade ^yAban on( System located at C 2,d ,'�_Z I.- 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: Construction must be completed within three years of the date of this permit. Date: Q - If- Approved by j ' A/ s. 10/9/97 NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) *,q/a dcAa IT- , hereby certify that the application for disposal works construction permit signed by me dated , concerning the property located at PC 4.4 v,,Il gLAcA/ae' meets all of the following criteria: �There e no wetlands located within 100 feet of the proposed leaching facility 9/, e no private wells within 150 feet of the proposed septic system • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • If the proposed leaching facility will be located within 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S.map) 7 B)Observed Groundwater Table Elevation(according to Health Division well map) S SIGNE DATE: LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert s C O _ V 1 1 11 1 \Ilk q 41 Fo 1 0 l n� JS�v � t i TOWN OF BARNSTABLE 4 LOCATION ��L C/1 A,y c�/ � L3;=AGft /Z ofl d SEWAGE # 'IF VILLAGE yYAwNis AD AZ-T ASSESSOR'S MAP & LOT f INSTALLER'S NAME&PHONE NO. ` �� 7 7 SEPTIC TANK CAPACITY t L O6 LEACHING FACILITY: (type) Lc'AG��, %, Iv (size) X X G�• NO.OF BEDROOMS BUILDER OR OWNER 222,9Y S 1 a 2%ZC 2 PERMIT DATE: ( // A � 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 i Furnished by 3AV L3sNns N N'VI OM 8 0 M o x 0 � � 2 �7 C7 p _ f.7 r , r ' m W m c T C7 � Zl Z O O _3 O TOWN OF BARNSTABLE LOCATION ��� C/1A��c�/�`� �eA�ft /Z.a,-*dSEWAGE # ?F— �- VILLAG `T ASSESSOR'S MAP & LOT 2'11Q-1'71 INSTALLER'S? iE P�NO. -"s r C� 77 S� 3 46 Z SEPTIC TANK CAPACITY LEACHING FACELITY:'(type) L�r�cif, j �, e /d (size) X ' X G�r NO.OF BEDROOMS / ° BUILDER OR OWNER m'9 2C �� 2'%ZE/t PERMITDATE: A COMPLIANCE DATE: - S� 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 r O CRAIOVILLE BEACH ROAD r LEACH TRENCH If C z fR W m u 0 �y FRONT 0 0 S O u � U O 6> cry . 17� TOWN OF BARNSTABLE O 'LOCATION ` -�CUa4e SEWAGE # VILLAGE ASSESSOR'S MAP & LOT -2 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY (9,SS pon/ LEACHING FACILITY:(type) L.P (size) NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER O O WNE DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: _ VARIANCE GRANTED: Yes No � ��� h �_�X�i�/ l Q e�P.� f2�' Lem No...... �.- .-`ff"�• ♦ �_ .il.. �V�_l FEB.. r THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTt-I - ....OF............ � Apli trathin flax DiSpasa1 Works Tonstrnrtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System ! --.. .----.-. ..�•V�•.......__.. n�:.:M.. . .... ._ . �J ^� ddress or Lot No. w Ow r Address ................................................... ............................................. •••---••-••----•••••.._.._..............--•-••-•-•...-•-•----••-•..........---•---•-••----•-•-•••- Installer Address UType of Building —�/ Size Lot............................Sq. feet Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No- of persons--...................------. Showers ( ) — Cafeteria ( ) Otherfixtures ------------------------- ------------------------•------••------•---•-••--•••-••••-------. w Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------.......... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit---------.----_-.- Depth to ground water........................ r3, Test Pit No. 2................minutes per inch Depth of Test Pit.---................ Depth to ground water----................---- fW .--•------•--•-------------•---------•-•------......---•-------.....----...........-•--------•---•--------•---•-----•-------•-----.........--•---••......... 0 Description of Soil..................................................................................................................................................................... x c, w _ V Nature of Re airs or Alterati s—Ans er when appl' ble- -----��`^S �•P" ---• . ------- ----- ---------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LE 5 of the State Sanitary Code—The undersigned further agrees not to place the system in, operation until a Certificate of Compliance has been issu o of.hea . Signed ----- --------- 1�� .../.. �. •7 1 _� ate Application Approved BY ---••-................ ......... Date Application Disapproved for the follo i g reasons:.-•--------•-------------------•----•--•-....-----------------------------------•-•----•-•••-•-••-------•...--- ...................................--.................................................................................................................................................................... t Date PermitNo...............................................••-•----- Issued_....................................................... Date `No..... ...: i.. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .......:........OF.............. 1-1..................................... Appliration for Disposal Works Tonstrtirtion Frrutit Application is hereby made for a Permit to -Construct ( ) or Repair ( ) an Individual Sewage Disposal Syste}�m(at• - .......1 1� .__.._.. ....:..fl:` �.A�1_........ IIJ �_. �C `._-.............. .:UIC/ J� 1............... 1 p y (�/�� Address or Lot No. ---- --•- ---- O er Address W Installer Address Type of Building --L Size Lot----------------------------Sq. feet . Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) P4 Other—Type of Building ............................. No.' of:persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures -------------------------------• •. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter------------:--- Depth................ xDisposal Trench—No. ................._..Width.................... Total Length...................... Total leaching.area_--_-__---_- _._:-_sq. ft. Seepage Pit No ---------- Diameter.................... Depth below inlet.........:..........:Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I----------------minutes per inch Depth of Test Pit.................... Depth to ground water......................... (X, Test Pit No. 2................minutes per inch. Depth.of Test Pit..................... Depth to ground water........................ a ------------------------------------•---•--•--•------------•---.....-----------..._..---•--..._...--......................................................... 0 .Description'of Soil........................................-............................................... ---------------------------------------------------------------------•--..-•---- V ........................................................---•------._...----••----•--------•-•--•-----------•----------.....----•---•-------••-•----•---•--------------------•---------•......---------- W U Nature of.Re aprs or Altera,�t',ns—Ans er when appl'cable_.__.. ...... ......... .......... .C. lea-...... _ K-�.S_____._ Agreement.: � ` The undersigned-agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of I of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been iss b Pboard of 1 e,4h. Si ned_...... /� � .t'� � 1/ g .. .. ...:z.--......=-- ----------- �1! ! Date - Application Approved BY r ......---•---•........... ... 1 �.�?' -•---- ----- Date Application Disapproved for the f oll owig reasons:----•---------------•---...........-----...------------•---•--------------------•---•--•--•............----•- .............••••--••-••••....---••-•--•--------......--•---•-•-------------•-•••••-•---•-...........--••--.......---•-•--••-----•-•------•...................................................... Date Permit No-----15.-T.-.....1.36--------------_------- Issue(L..............................-.......................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF TUrrtifiratr of Tootplianrle THIS IS TO C RTIFY Tihat thy,hndi 'dual Sewage Disposal System constructed k or Repaired ( ) by........... lj '6'.:.-^...--_ 11 CCJJ.._.......JJ......-- •-, _ ,y I nstaller,^•............................'•- ..................................... --•--•--..... � ...-..-;--•--- - 7 has been installed in accordance with the ovisions-of TiTLC: 5 of The State Sanitary C9de as described in.the application for Disposal Works Construction Permit No......................................... dated-.-. ................ THE ISSUANCE OF.THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT YHE SYSTEM WILL FUNCTION SATISFACTORY. DATE................2---`-- --------------•---------------- , Inspector.... �• � li�� THE COMMONWEALTH OF MASSACHUSETTS J BOARD OF HEALTH --- 1 � 7 � T...)...............................OF..---•--..,�.�-- .. -........._..-•----•--................._............ J No... .... . ..--•--• FEE....................... Disposal or o Tonstrudion rrntit .,. Permission is hereby granted ` �`------.-4•4.--h..J1 -------•-------------•-----------:-----•---•---------�:... to Cons Uct ()) or Repair ( ) an Individual Sewage Disposal pSystem at .2. �!� ......•.cY.... /.4...................... �,t ! Street -7 as shown on the application for Disposal Works Co struction Permi No....................�Date ._____.__.. ...... _...._ G?�! _---------- Board ----- of Health DATE FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS COASTAL ENGINEERING CO., INC. 260 Cranberry Highway SHEET No. ORLEANS, MASSACHUSETTS 02653 CALCULATED BY DA f (617) 255-6511 CHECKED B^VIM DATE_ .- SCALE i ........... ...................... ..... ..... ..... ...... ...... .........i............_i.. i i .... ..... ..... ...... ..... ... ................. ............. tA .. .... ....... ...... _./_ .... .... ....._ . _ . _ _..._... .._............ .... ............. ..... ...... E F6'.',LA I L , 'J . ....... ... ..... ..... .......... ..�._.__.._....._....._._._...._....._..._ ........ ...... 2 S yxl ..... ..... x E� EL. 5 58 _ : _.......................:..............:............_:......... �.Q< ..... ly ..... ...... ..... E 5 ... .......... ........ ......... .......................... ..... .._.............. :.... C,, } ....:.... ....:.... .............:...... ........;..... i. ...................................._..............i......._..........._ ..... ..... ...... ..... .................................................... .... ..... ..... ....:.............:.... ....:.... ....;..... ....:..... ....:.._ ....:..... t. .. ..... ..... ......... _� ......................._:................................... .... ..... ..... ..... ..... ........ n F . ............ .......................... 3 .........:.:.... Y ....:..... ........................ .............o .... .. ......... ........... ............ ............ e6 � ..... ................... ... ..... ..... ....:........ i 2 h u .... ............:..... ... ._f fill ..... ... ......... .. .... ..... .. .. .. o. 2 �J FQor1n t e D la ll� C : . ,b 5E: 0 ....,...._............. ................. ..................................................................:.............:.............:..... ....:.... ....:.............. i .............s............_.....................:....s.................................................................. ...... ...... .<.... .... ; This is an informational documenf .... ........................... _...........................:..................................................... to be used..on(y. or...evaluation...... ._. ° . purposes The Board of Health _.... ... ... .. . ...:. . .: .... d , No guarantees or warranties of ........ .... > acenrgr� �t� xpr sse or mpl ed. ......:......_..._.................................................. ...... .........._-_... ...... ...... ... 41 ....:.... ...:.... ....:.... ....:.... `:. ..... ..... .... .......... PRO=ION a 1n.Wt..Mm OIUI. CIO-669 J AREA I SEPNICE0 ti \ BY TOUJO \,AJ ATE Q, le• /� r`�\ po!,T d RAIL �'� ; - ,AST LF•AC AVEa FENCE'.... q a / 4 BF��QoolY1 \�29e L t cpw.1.18)\� \ O ` \ Ol i 5 G(EACH '� LEACH / q ! �' I \' c►I^kmq CNA14 �8A20><I� ' / 1+orvNo �i _ E�L'.5•oMsL �v • n (RHIr VILLE T QUA F - --- - - .— - - .- - - - - -T zoo'} TO MH\A/ 501 L LOG _ TBeZ(EL3 68) (A Lor+(')jS44JO (. ... -... µ S�INO'!F• ' .4f".•..F -TAPE PLAN FoR 2.0 Ha�rLy ' CQA16VILLE CEAC 14 u �roy 3o Siirl SANO �/` CP%'6VILLE,PIIA. ' m C E01V OR, MAC SHEQTLER `SFwp 5CALE (EL-03)MAX ' =fROM 20r. Coastal Engineenng ."o. 70 IILOUIS N.D..WMW CIVIL-STRUCTURAL-ENVIRONMENTAL-ARCHITECTURAL Iolzoly9 260 Cranberry Highway Orleans.MA 02653 (517)255.6511 ON4,15TABLE Co.1MA i his is an informational document to be used only for evaluation purposes by: The Board of Health No guarantees or warranties of ace--jraty are expressed or Implied, i ASSESSOR'S MAP ) "71 PARCEL 7- 6 UO CAT 10N SEWAGE PERMIT NO. Unx VILLAGE I N S T A L L E RA NAME i ADDRESS IVR c B U I L D E R OR OWNER e. DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 3 "7 r NOTES I ALARM TO BE AUDIO AND — 1000 GALLON PUMP CHAMBER i - VISUAL y� PUMPSHALL_RAVE SHA HAVE INTEGRATED MODEL SHOREY ST 1000-H-20 UNI:1 ON BO:^ k., QIJID, rlL S Y / r<(" 1 hgJTT(rK- N��>E ? . All construction methods shall conform to the Title V _J OVERLOAD PROTECTION SCALE DISCONNECT PLUGS TO BE. L C,LR�+� fP�c& TEST PIT DATA 0 IXCMR 15) and the Barnstable Board of Health Regulations . ! PROPOSED GRADE LOCATED+JUT SIDE OF TANK _ % r 24"DIA % I 24"DIA (MINI -�`- JUNCT ION' TiON BOX / !erforn�ed By: Daniel B. Johnson. _ . There are no known private or public wells within. 15C I SEE "PUMP CALCULATIONS"AND HARDWIRE CONTROL_, feet/400 feet, respectively, of the proposed leaching area. 'FLOAT -_- -- TOCOMPLYWITH It '' ( MANUFACTURERS Witnessed By: Don Desmarais The proposed leaching area is not within LOG feet :,f a � FURTHER DETAILS dLSC5 4x10 - FLOAT RAIL SPECIFICATIONS Cjl�r/A6. wetland, nor is it within 200 feet of a river front . 6., (11,'4'SCH40PVC) FGnt:.f q"ScN 4 o Date: October 5, 2006 PUMP CHAMBER TO ME*"_" HIGH WATER O- ` ' SCH 40 PVC.EL =4 9' WATER TIGHTNESS K �(HptL S%.ot t�' SSE° ��r��'` 3 . The existing 1500 gallon, septic tank shall be pumped out I AND PUMP TO HAVE OVERLOAD ILr p � la'DIA WEEP HOLE K1114 � (M+N.) '�� (,�pRo�) 5r►� o� TP-1 (ZL. = 7 .t) completely and inspected for water tightness/leakage. ` PROTECTION PUMP ON t 00 , 9'S t F�' Install 1 1 r ';^ ( 4"SCH 40 TEE o CHECK VALVE E;g,95 11,4 6 �nsta__ a new outlet SCH 4 P �. tee and filter 1n outlet of CONCRETE RISER� ,, � � H PUMP OFF r u' -- - -- TO tZr i,A(- ( 6. 9) A, 0" - 6" 10YR3/2 Loam sand tank . Install a concrete riser (H-20) and childproof metal METAL CHIL.DPROOFCOVERDOVER MEET REQUIREMENTS CHAMBER ENT -. F OUTLET OF PUMP CHAMBER TO RE UIREMEN, ( 6. 1 ) B/C, 6" - 16" 10YR416 Medium-coarse sand rover to grade) . If tank found to be leaking or BE\rIATERTIGHT jI OF210 CMR 1523i n�pirE` 1 - - _ $- 40 �� Y ! 7x I, (0 . 4 ) Ci, 16" - 84" 2 . 5Y8/1 Medium--parse sand structurally sound ( including not H-20) , then a new - H-10 t� - 2 . 5Y5/1 "Monolithic" 1500 gallon (H-20; septic tank shall De EL. -0 45 _ o 0 o CRUSHED STONE 6" (MIN 1 </=3`DIA STONE I --I -- -fl oPoS�p (2 . 84 ) �0" Otserved GW ( 10/13/06 ) installed in its place . o ` �r� �'S— 1� � V � � ! LIFTING CHAIN SECURED TO � __—_ � TO BE MECHANIt4LI` ( E`f S1/N(�- SEPT/L T/fNK r/►l/vIt* STABLE LEVEL BASE I:rr� __.__._- _.-._-.__ FLOAT RAIL AND PUMP.(ACCESS COMPACTED ! +� ,� I (T°ge ,ee OVF-D) lox I �rON A`L I! T'P-2 (BL. = 7 .1) 4 . No changes are to be made in the field without the approval � FROM MANHOLE;. ALL VALVES yE E,>7,�Ep� ��` , ! t' Ir — — — -" - -rP_7g SSE_ peTANL) I - of the Board of Health and the design engineer, 00TFlTTEDTOBEREMOVED TANKDIMENSIOINS 9'LX5'3"WX6'H AUNIONTOBE V ` ( 6. 9) A, J" " 1 OYR3/2Loamy ! INSTALLED AFTER THE 90 2 sand t , ( ( ,. c ALL WALL SLEEVES/GASKETS MP SHALL BE INS ALLIED IN STRICT CONFORMANCE KITH DEGREE ELBOW AND C/La�EL`� . y L ( 6. 3) B/C, 2 = 10" 10YR4/6 Medium-coarse sand �• Proposed leaching field is not designed for use with CAST !N PLACE OR!NSERTED MANUFACTURERS SPECIFICATIONS AND SHALL BE EQUIPPED\•V'E:PHOLE OF THE a 'b D jU WA,- "` P 8 I 5 qoM (v . 11 �1, 10 84 2 . 5Y8/l Mea_urn-coarse sand garbage disposal . Remove any existing garbage dis csal/s . AT FACTORY APPROVED vJfTHAN ALARM POWERED BYaGRCUITSEPERATEF-OM DIS CHARGE FORCEi�AIN �/tDP S L i E ( m I r . _ v p PENETRATION SEA METHOD PUMP ALARM TG BE LOCATED WITHIN BUILD NG 10 D A L L o r1 ^i - -t--__ I r=- . 5_5/1 S l zi 4 Q B��- ( 2 . 84 70" Observed GW ( 10/13!06 - 6 . Contractor to notify Dig Safe 72 hours pr=or tc ! - __------.__ _. _.__._._�__.__. __________� - _.•___� � __ a_ S�•PtIG TANK #2 ($k ., w - -�- C s T__ ,. _ _ S�� construction. ( 800) 344-7233. i tSOU GALLON scpT!cTaNK. Monitoring Well installed within TP-: . The tollowin were the g j MODEL SHORE'r'S1 1500-H•20 -� gtr #vArWx.7I& � - - - - - �_ -- ' 1 �EA`k/n/b elevations observed within the monitori.'1C '.;el; between 10/1 Property line corners and property lines along the proposed leaching FINISHED GRADE �a�>E � �EN�,►�a�-K � � through 11/7/G6. aching field have been staked and marked in the field by a � _ _ t 5 ���°C T 7 N(f�a�! ` �o ,c /5 w 0, N professlona_ find surveyor ; see plan view) . The propel -',� ! - �'- 2 �91MIINJ 24"DIA 4"DIA d(-D� [L's j, LE .c / Elevation from Depth to GW Elevation of Date line information taken from Subdivision of Land, I �,NE� 7�P �' ,r MW "� F M F "Crai; ville"-Barnstable-Mass . , I -oA 0f from t� of 'groundwater of Obs . prepared b} Bea�se S 3•. +t. H %rJ ,;L I Kellogg-Civil Engineers, dated October 20, • 1949. Reference II r - { Plan Book 92r Page 135 (Lot 14 ) . The sepri�� , ^� + c S it / . 84 10/13/06 g - - _ plan is n, p / I ` CONCRWILET ETE RISERS(H 2Cl)D OUTLETL'r 4"SCH a0. EL. =6.45 q•;c.� 4 be iced as a property line survey• I ; 4"SCH 40 LOW LINE FFf 9 5' . 67 7"" 10/17/0 6 AND METAL CHILDPROOF 10 tr' F 2ABEL FILTER ,4 t0ii • t S= �� .r ,�'F - q +- :?,1 1 67' feet horizontally ar«�_rnd' the pro ©wed leachinc atR,3 COVERS TO EL =6.10 y T � � ,�,N•1 EI,, L► Remy /�= � �. Q � SEPTIC TANK TO MEET. ! / ULRwL SPt+c.E) / P• ' 8 . 67 71•• , anti t,� a dA th of a roximatolV 1' bQ1c;w gT.?90-10 {t:op-Pot } j WATERTIGHT} 4"SCH4CTEE 4'LIQUIDLEVEL REQUIREMENTS OF 75 _o/24/G6 lP PP 8llrj A- Byer! , _ t �:.. ng ar a71 f any 4"SCH Nil I� WATER TIGHTNESS. ��. S BAFI iE 31D CMR 15.225 FOR / �1 ,-•fl w1 11 1ro a• is+ i ®n t7 ,• + ,�� r 8 . 6 . 67 10/26/05 a trot it'par t e 9 pryf 1 , i f rIc ni tine i arri ' �I ! a�'� W I r►, TEE ETC. �• �_ —.. I ( _. _._� y 1 1 f Ic Fi l 1 t9Rht_j, rr,f , 7 ! t:qt, 1 't'Itn + 7,nr• rrit r Ii" 75 r + 1 1 a ►Irj) i rj r1t ar•► 11 •t o I !, t ALL WALL SLEEVES/GASKETS _ 8 . 67 11/07 06 I / 1 ( SHALL BE CAST IN PLACE OR 6" (MIN j EL =1.95 - MECHANICALL`; CY` Sr/N� fit# r' ( f i i ( garr•l t n,a', r hrc r,.at t i a . as3•, I .•� INSERTED AT FACTORY o ��- O COMPACTED _. 0 1 11a1 a+i ors i aI ► I. r ,,,,11,•,rrl 1 IOU L,1 r+ko, 1gn-1 I ts.a, }r i rr j CRUSHED STONE DUPLE $, N ou.SF �tiA#4 �Q ' PERCOLATION TEST DATA 'jtica . STABLE LEVEL BASE .2/4"DI.A HE D 1 { E t't t+L T WK DgrtEt4 ?NtS t 1'1 x 2' w x s k _ t �, 9'S (A!'PKo�.. 1 Date : October 5, 2GG6 � '�• � J+i. 1ut i .,t �Allgll Vt�/ 1Cy all. ��1t.it{i�it#ii;� Ci�atfi �s'►lrat llt+j "N I ! TJ•r'r ' d,g t W i i 1 00 l ttW s#&iMt .1 a'(t3t 43lR fit 1Ut I I .unotruct ion, if any exietiny (:lambing exiting tt,e tit . ,&AWL_ 5PALe.) moil Class : amass I (0. 74 G/SF) DISTSWOTIUNBUx. J M ! I 6trucLura is found C(� be difftirent the thalt shown on ine Qerc- I�Pth : + " "*p + P° -- ; . ; dPProved septic syst*m plan, the contractor shall notify c.he MODEL SHOREYDB 3 `r I ieign( r. All internal plumbiny snail be ccnnected to new REMOVABLE COVER 4"SCH 40 OUTLET LATERALS tl(, system, tanlms otherwise spec i f:ad. DISTRIBUTION 60X TO MEET /` SHALL BE SET LEVEL FOR A REQUIREMENTS OF 310 CMR j MINIMUM OF THE FIRST T\v0 S 0 For _. ISZ32(WATERTIGHTNESS / FEET AND CONNECTED TO Z CONSTRUCTION.ETCI. I ' ( EACH DISTRIBUTION LINE - WITH SOLID SCH 40 PVC PIPE VARIANCE : VIA LOCAL UPGRADE APPROVAL NO OF OUTLETS 4' SCH 40 6" 00 �ALLaN 6' �- USED 3 EL =875 EL =858 D ? ( inr ` P a Ne uest variance to reduce the o ° 6" MIN o -- CRUSHED STONE </-Nit" leaching area to the DIA. STONE TO BE POMP G MA r+t��' � DECK j � P,,,,,. o. `4 f�s e t o f the proposed s ed (MINI �Rtt �Av°" ^' �O �OpNQD/fu� �`to,. ..e J, _� g property line from 10 feet to 5 feet / o o ° M IN o L,TN I G + I -«",v y Ry r 'aa: b c` r zs 310 CMR 1 5 . 4 0 5 ( i ) (a) . 3'SCH 40 PVC TEE STABLE LEVEL BASE MECHANICALLY t`y0t1� .'e< r(,EA ? I COMPACTED c I _ CONCRETE RISER AND METAL _ r'HILDP9nOF!"OVER TO t7RAPE s a o reduce the offset of the proposed septic 1 M r •f� w:. ENT ,p , Request variance to w ,e l nrlk and pump chamber to the property line from 10 fees, to L�Ap� e. y LAKE a` Y ��,AN/ifrgr 4/1)HP 7 feet, 310 CMR 15 . 405 ( 1 ) (a) . 7 7? _ yN / � ,FJ15 KL ' aL ��s � ELIZAOLTN a � � �/ Sr AI �� ` NO. OF ACTUAL DISTRIBUTION Q�3 � Z,�l,) a } �z `" i2 S Request variance to >•educ:e the offset of the proposed ' LINESs t"� P uM�V7�ic tsrn"+ RD leaching area to the foundation wall (craw space) from 10 l LENGTH OF LEACHING LINE 40' LEACHING FIELD --j--- _ �1 V �� > I/ r x , ° Peer to 5 feet 310 CMR 15 . 405l1 ) (b) .r" 4 ' i LEACHING FIELD DIMENSIONS a ' $ o n I "END" SECTION 40'LX1S'WX0.5'H { 1'� r b L 9r $ Request varaance to reduce the offset of the + FINAL GRADE TO BE STASILOED -\ SSE = NONE / b '; ytK 7t�3 ^ °��< «",�� 4; a d tank and pump chamber tc the foundation wall ( crawl space)Septic +1 L %L�� < qc I EL a iQ0 PNISHED GRADE(SLOPE 021 tfam 10 feet r-o 5 feer , s 0 +iR 5. 405 ( 1 ; (b, , LFrJ�� of _ _ U �,,,gNT 1 0 zo 40 w .o too Nzo I 4"SCH 40 PVC RPE I I 1= III III= L,4 G PA E �,yr y \. ( ( CAPOGITY•U 6.0 P.M. I 12"(MIN) E: -9 04 - 5'---a Z'LAYER 1/8" t 12' DOUBLE (p et(t ox' f?� -- � p[>MP C�IL�CR.A'r7.'dIP 1 '_ •p � m .. GNASHED STONE PILE-�1; S 6 Total Mood tlootl 12-�14 _ 10 li SO 21 IBREAKOU T II I 'r(N y I } 4' 5' 5' 4' 9 � , 6►M 4/10 HP 71 5I 40 21 7 0 _`a• _.. Head: Ei . 8 . 75 - El . - 8 . �5 T EL. -a34 J50o G�u-o� l Re -_ k STONE RET � ORIFACE DIA G,e - I{ WALL ISE F. � 5' 3/4"-1 1I2"DOUBLE WASF s CP rr L T•4r•1 K - -- --- (SEe ©tE 3 ) Dynamic Head: 76 FT X 1 . 80 FT/100 FT = 1 . 4 FT DET,AILI o STONE 1 _ t 5' EL /.84 ota! Dynamic Head: 9, 65 E"" 90 Gp M� -- W 40 MIL HDPE BARRIER LEACHING Fif LD TO MEE T 5' REQUIREMENTS Use: Model : H dromatic SK50 (or E uivelant ) TOP OF BARRIE14 ATE L. 9.5 ENTS OF 310 RE REQQUIREM OIGI�� Q � SEPT�L SYST-f; y q 4/10 Hp, 11G Volts I t1 SCALE : A� SMo.�Nr1 PnttnMnFE�eRRIERA1El •S.5 LfLo S S SF�7 t cent '� JnIC. 2" SO11dS1 r0f OH9TAIi0TION LINES ►(l ll "dttw QWL + 44) ,✓N�rAt GµlL.dl«k.�F SEE liLi Co�v�. �-+SEAS ��"�°� GmVE2 QQar,� RoPaiED stoo L irq 1 Gallons Per DOS(--, f 4 , Per ..ay t vIl�rf601i~ WgwwN�p►tt__ _ _- _ - ----- 36 G llon Uses 95 , w/ MErA,L LNrc.arRuoF 9 S WuoE ! ." ° • c7;�T�41 ' co�tetLS 70 6 ,40E, — RE7-A/, ly c. 91 ' �X I SrJNcL INA�C (jl.Tf aerAIIt,} iLL7 SCHEDULE "DF ELEVATIONS �A.ADE vRz,ES - 40' W�w�St:E AleT,4Nt} C71L(.`iJIJ1TZ0�I8: env. Out Foundation (existing) 5 . 6 ( 1 ) 2rt.P�IE4 Inv. Out Foundatioon 4 Bedrooms (existing) �-...,�, -...---' rt_ S:•ot q">crr 40 ?f�+•� j�L� - ,3 , �MdIl. � 6 . 75 (2) � ;:I (M+►,�� ,�JL. le 4� -�_ S-,vos A R 110 GPD/Bedroom X 4 Bedrooms = 440 GPD , $PA" �--- � ay v. In Septic Tank (existing) 5 . 5 tll Percolation Rate - < 2 MP1 _Lass ( 0. 74 G SF z,-_ ____. env. In Septic Tank 6. 70 (2) 6A X-Mt D$ 9 5�� S q E�4 r r r t= i Septic (existing) 5 . 3 c.N rub env. Out Tank inv. Out Septic Tank 6. 45 (2) } aLAb R jc 8,75 o'L �SvvxDrSN I _nv. In Distribution Box 8 . 75. I �P089D �MIM Ate: �l ��� �� 49/ 4 ,I J /V1 1` T Se��� °a r "1 _nv. Out Distribution Box 8 , 58 � 6 - / s JtDPP 1 :nv. Begin of Leaching Field 8 . 54 Leaching Field: 40' L x 15' W x 0 . 5' H �'« , / �X ,r�� S G-ti40 b'75 5 �� Bottom Area . 600 SF X 0. 74 G/SF - ,,,q End of Leaching Field 8 . 34 ' 4� GPD 70 Cf 3 r .,,,. �3'S��4° ForLLeMA��J �tpc*cE 5 ctr_om of �eachinc Field 7 , g4 I Total Leaching apaci . , . 444 GPH OkiS,-�J q,95 �ro Sc.oPE $AGK ror�MP) �Se E Norf) + SS Observed Groundwater ( 10/13/06) �.__ �2 . 84 -_ 4 LZGM if, !Lt'W 'SWTTCRRS JJ�ltl �A- A4. r ( Existing Contour - - - 98 - High Level Alarm: 18" (EL. = 2 . 0) �aMPacr�O UgS' ; roposed Contour 04,6-t4ESr AfAniNb- /0(/3/06) C 98 + - � /Soo �.>,«ort � !i °,Imp On : 12" (EL. - 1 . 5 ) � '36rE �, ,aN �(IE�V foR ''�+' 6L Ev.4Tl oN o Test Pit S t SEPTIC raNK N� = (..WA�� /. 3r4r�-rE�Z .lLlvo L oc•.�rco�� � Pump Off: 6" (EL. 1 . 0) (=in 1.shed Floor Elevation FFE j _ of ,--a,de o.�►c,� --ru bE w,+rE� 7"iFMT� g r Reference from bottom of um /000 (TAAl.onr ;7�.semPnt Floor Elevation 3rF x* pump chambe- � AMP G��� 24 Hr. Capacity: 675 Gallons SUBSURFACE SEWAGE DISPOSAL SYSTEM 862/864 Crai ills Beach Road Centerville ( 8 . "2' L X 4 . 4'W X ?_ . 5' H) X 7 . 48 ';!rF rd 9V o P „N%� Walter Line -�•• W r w» Inclu,oes Bac.k Flow: 25 Gallo � M`�iN•a ��f SCALIIs APPROVED BY: DRAWN BY DQaS itta 4 *�,lI16?Z/'•S.s�,t e��: . 3 6 Head Wire �� •++�-�+ � < DATsi 11/9/06 Daniel B Johnson REVNBED �£l/ S rtzer !Tt. For 864 Craigville Beach Road, Centerville, MA 02632 w..•ri+r,. rw.•r,r•• as p TC DESIGN, rNC, (509) 4-77-9909 .-t 0 p+to 0+.10 0+30 0+40 utj0 Or9 pt90 f a /DSO Itba f o f '4 /'I'�O l7°gJ / 9 � t 0 0 4 p DRAWING NUMBER ♦r0 9`', By P O Box 831 oaterville, MA 02651, ,