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HomeMy WebLinkAbout1758 FALMOUTH ROAD/RTE 28 - Health (2) 1758 FALMOUTH ROAD, CENTERVILLE A= 189 036 1 UPC 12534 ' No.2_ 153L OR HASTINGS,MN .av Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °t 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 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. Please see completeness checklist at the end of the form. Important: A. General Information When filling out i - forms on the / computer, use 1. Inspector: only the tab key to move your . Matthew F. Gilfoy cursor-do not Name of Inspector use the return key. B&B Excavation Company Name VQ 14 Teaberry Lane Company Address Sandwich Ma. 02644 Citylrown State Zip Code (508)477-0653 S113640 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 Evaluation by the Local Approving Authority 4-10-15 Inspe . s Signatur 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 Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 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 an information which indicates that an of the failure criteria described ® y y e a desc bed in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M yy� 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. Cityrrown 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 0 Y El N 0 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 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well"*. Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"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 '/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is Centerville Ma. 02632 4-10-15 required for every page. Citylrown 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 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? El ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. Determined in the field (if any of the failure criteria related to Part C is at issue ❑ ® approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 368 i t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 • I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. Cityrrown 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: 2013- 37,000gallons 2014-22,000galIons I Sump pump? ❑ Yes ® No Last date of occupancy: current 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 f Commonwealth of Massachusetts w . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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): l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every 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: 2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2-4„ Depth below grade: 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.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal El fiberglass El 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. 4" Sludge depth: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every 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 32" Scum thickness 2 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 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.): 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 4 M ,•�''r 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every 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.): At time of inspection d-box appears to in working order no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: (4) high cap infiltrators ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Leaching was dry at time of inspection. 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 l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required fbr Centerville Ma. 02632 4-10-15 every 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 �aY 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4=10-15 every page. CitylTown State Zip Code Date of inspection M 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: Z hand-sketch in the area below El drawing attached.separately b-bok POA a .3 0 n 6 . Z _ cl�-anbu.#` dwn ou = 1 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts 4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is Centerville Ma. 02632 4-10-15 required for 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: Gw 11' feeee t 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: 5-23-08 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: Plan on file 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 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1758 Falmouth Road Property Address Jasen Muto Owner Owner's Name information is required for Centerville Ma. 02632 4-10-15 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I L15,n. /13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 No. .`Zdo(,- 2 2-® Fee I®G / THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: v/ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes pplicotiou for Digonl *p!5tem Con0tructiou Permit Application for a Permit to Construct( ) Repair(tl<Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. / i 1 -6�7b� Owner's Name,Address,and Tel.No. "f C•v Assessor's Map/Parcel 4 s 04 Installer's Name,A�ddress,arLdyTel.No. Designer's Name,Address and Tel.No. Type of Building: _ Dwelling No.of Bedrooms 3 Lot Size ����S sq. ft. Garbage Grinder Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided (y gpd Plan Date F /a ?/R sr Number of sheets Revision Date Title Sc.SSSy�o-°�{� SIE�.✓a4r� 1'JI S�aSA(, S`! S'i '+� 1�T �� FINL—Vv�­11A 3Z�. Cs��vz+h,Lv��� Size of,Septic Tank Type of S.A.S. rS W J'1rr'-p- C - s � Description of Soil C->cqr � ®L x I'®. Nature of Repairs orAlteratioits(Answer when applicable) t! �5co 6r,L Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by Date 2 g C� Application Disapproved by: Date for the following reasons Permit No. 2-y D 2 ZC7 Date Issued S Z f ————— - �. ... - _ .. SIAC No. 2 40 Z 20 { Fee /0 0 ---� THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpprfcation for �Digoga[ �&p!5tem Construction Permit Application for a Permit to Construct O Repair(till'Upgrade( ) Abandon O ❑.Complete System ❑Individual Components .fM Rd Location Address or Lot No. �7�� odic Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ` .03� 7 Installer's Name,Address,and el.No. Designer's Name,Address and Tel.No. soy aqy ooeti Type of Building: Dwelling No.of Bedrooms 3 Lot Size r� 7l S sq. ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ,\ Design Flow(min.required) ���/ gpd' Design flow provided 34, gpd Plan Date _!�- /,A .1 f A 5r Number of sheets Revision Date Title Sc,6S(jab (� SF-,,AGC dc,00SA(, Sy $'frEw� �,-( Sf� FIN-L—V%.ijo V-h Ctfr.,T Gvt� t.,t a Size of.Septic Tank Type of S.A.S. . (f 7"Q,. i+C-C-01 rS W J*{ P_ Description of Soil C e- F >I I Nature of Repairs or Alterations(Answer when applicable) ``� IG C.QSS,P D v �5 /,0 0 `AL Q CS44 t U N< CQ-,Q Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. cc lz ! Signed S Date — o f Application Approved by Date S/2 & C90 Application Disapproved by: /� Date for the following reasons U ...,_..,.., Permit No. Zoo.&- 2 ZC7 Date Issued »_��_�-_---- T- -------_ ----- — -- =---= --- 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 4,k M h tC���-/ r^G 9 C c i at ��]yr FG►� I�C�V��•- C• V ��(� has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer SC6 M t-v��`�- Designer �0\e.,^ o--XS #bedrooms �? Approved design flow ,?( � I \ ��{ gpd The issuance of this permit shy note be cogst�ru d s a guarantee that the system il�netibn as designed. Date✓ Inspector No. 2GOfjj Fee rT/00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS lwigoar �&pgtem ow6truction Permit Permission is hereby granted to Construct ( ) Repair ( ) Upgrade ( ) Abandon ( ) t System located at R1 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: Construction must be completed within three years of the date of this pe it. Date S - 2 6 — 0,5 Approved by �V i Town of Barnstable Regulatory Services �., .. Thomas K Geller,Director- •- �� Public-Health Division o 7 Thomas McKean,Director., 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Desisper Certification Form Date: sl o Sewage Permit# o;U 0 Assessor's Map\Parcel 89 0 3 b Designer: b/+14/eL J Z>141gS�N Installer: Address: 00. 0, 0,0 X S;r 1 Address: \C` C2\-C) YCu n, nct me Ua(OV Onjob?' 10 ,S _�� c n �rt^-�4--was issued a permit to install a (date) (installer) septic system at 175�8 6401-10-r-N /Zo of b based on a design drawn by (address) 6e-,uTEl\jiILte b,¢r,�t eL 13, .���}rtS o� dated ,512 r/®-a 2&—d` g-12>jo 8 (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 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 Reg4att ons. Plan revision or `~ certified as-built by designer to follow. (Installer's i e) (Designer's gnature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF. COMPLIANCE WILL NOT BE ISSUED UNTM 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 TOWN O(F.�BARnNSf TABLE v LOCATION ��� PJ�\�`^Ul�1 y. ��1 ���SEWAGE# VILLAGE (T_:���`, L ASSESSOR'S MAP&PARCEL Pig — INSTALLERS NAME&PHONE NO. S C� �T"^�' S O K a ri(-E y Y0 9 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) l[ [A"r Cruo t� i t S� �L X 104 (1 % NO.OF BEDROOMS V i q Off IK OWNER PERMIT DATE: /0 )r COMPLIANCE DATE: o�' Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ry A 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 PLC n II r OCCIAOIA - Fz /A+p .sue Fr dr,& it Si �C� SA (3m 7 5 A -+o 71,vaeCa i3 4b Asa Town of Barnstable P# ; Department of Regulatory Services Public Health Division Date >� G 19. 200 Main Street,Hyannis MA 02601 Date Scheduled (/ Time Fee Pd. J/0 Soil Suitability Assessment for Sewage Disposal Performed By: DA-N t e'Z- Witnessed By: LOCATION& GE RAL INFORMATION Location Address 1 Owner's Name 17 arc QC,,jW dvjcr1 Address Assessor's Map/Parcel: ( — D 3�O Engineer's Name �^ NEW CONSTRUCTION REPAIR --L//— Telephone# pZ Z V -,goo-) Land Use Slopes(%) ey ot Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Lane ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) 7+c " 44 g .4,0 srs" p�LK � 5< - - _ i P1.) r�'y G . I Parent material(geologic) Depth to Bedrock �,[✓f l Depth to Groundwater. Standing Water in Hole: /`� A Weeping from Pit FaCe 0 Estimated Seasonal High Groundwater —7 !� 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 tt. Index Well# Reading Date: Index Well level Adj.factor— Adj.Groundwater Level, PERCOLATION TEST Date �;?Tlme //'ors Observation Hole# �P r Time at 9" Depth of Perc Time at 6" Start Pre-soak Time @ if" °Z l Time(9"4") End Pre-soak 17 .t. r Hvi-* �gGy4�zau Rate MinJlnch f etLe.f a.4/: Site Suitability Assessment: Site Passed t/ Site Failed: Additional Testing Needed(Y/N) f Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPI'IC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. On l tencGravel) = -76" 6,1 G c os /0 Yes- 9 — 0'f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.% ve $o`=r3�� � o S �,7� 7 Z — Hof�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,%G ve DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ten 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? f -- If not,what is the depth of naturally occurring pervious material? ..� Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainingexpertise and experience described in 310 CMR 15.017. Signature Date ✓- 7_3 o Q:\SEPn0PERCFORM.DOC c ; t BORTOLOTTI CONSTRUCTION, INC. ., v SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Address Prop o Ale Date of Inspec} M��� ��,7� Own PART A — CHECKLIST CHECK IF THE FOLLOWING HAVE BEEN DONE: I�PUMPING INFORMATION WAS REQUESTED OF THE OWNER,OCCUPANT,AND BOARD OF HEALTH. ONE OF THE SYSTEM COMPONENTS HAVE BEEN PUMPED FOR AT LEAST TWO WEEKS AND THE SYSTEM HAS BEEN RECEIVING NORMAL FLOW RATES DURING THAT PERIOD. LARGE COLUMES OF WATER HAVE NOT BEEN INTRODUCED INTO THE SYSTEM RECENTLY OR AS PART OF THIS INSPECTION. AS—BUILT PLANS HAVE BEEN OBTAINED AND EXAMINED, NOTE IF THEY ARE NOT AVAILABLE WITH N/A.. HE FACILITY OR DWELLING WAS INSPECTED FOR SIGNS OF SEWAGE BACK—UP. THE SITE WAS INSPECTED FOR SIGNS OF BREAKOUT. &--AALL SYSTEM COMPONENTS,EXCLUDING THE SAS,HAVE BEEN LOCATED ON THE SITE. V 7HE SEPTIC TANK MANHOLES WERE UNCOVERED,OPENED,AND THE INTERIOR OF THE SEPTIC TANK WAS INSPECTED FOR CONDITION OF BAFFLES OR TEES,MATERIAL OF CONSTRUCTION,DIMENSIONS,DEPTH OF LIQUID,DEPTH OF SLUDGE, DEPTH OF SCUM. E SIZE AND LOCATION OF THE SAS ON THE SITE HAS BEEN DETERMINED BASED ON EXISTING INFORMATION OR APPROXIMATED BY NON—INTRUSIVE METHODS. -THE FACILITY OWNER(AND OCCUPANTS,IF DIFFERENT FROM OWNER)WERE PROVIDED WITH INFORMATION ON THE PROPER MAINTENANCE OF SSDS. PART B — SYSTEM INFORMATION RESIDENTIAL FLOW CONDITIONS No of Bedrooms Q,�'G�p1 No of Current Residents ;Garbage Grinder Laundry Connected to System. Seasonal Use NON RESIDENTIAL: Calculated flow WATER METER R INGS,IF AVAILABLE: GALLONS Pumping Recbrds ancVSoufco of Information: SYSTEM PUMPED AS PART OF INSPECTION?IJ16 IF YES,VOLUME PUMPED = GALS Reason for Pumping: TYPE OF SYSTEM: Septic tank/distribution box/soil absorption system Single Cesspool Overflow Cesspool Privy Shared system ('If yes attach previous i pection records, if any) Other(explain) pW �S �S Q s Ap oximate age of all components. Date installed,if known. Source of Information. SEWAGE ODORS DETECTED WHEN ARRIVING AT THE SITE? Q , SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SEPTIC Depth below grade Dimensions: Material of construction: Concrete Metal FRP Other} Sludge Depth Distance from top of sludge to bottom of outlet tee or baffle 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 Comments: DISTRIBUTION Bl X: 410 DEPTH OF LIQUID LEVEL ABOVE OUTLET INVERT Comments: PUMP CHA BER: Pum s in working order? Comments: -SOIL ABSORPTION SYSTEM (SAS): IF NOT PRESENT,EXPLAIN: TYPE: Comments: hell o�J c n. CESSPOOLS:k7 Number and configuration Depth—top of liquid to Inlet Invert Depth of solids layer Depth of scum layer Dimension of cesspool ,Y ��(,J Materials of construction Indication of groundwater inflow(cesspool must be pumped) Co wont f?OUteJ" �' �4 /t2o� PRIVY: Materials construction Dimensions Depth of solids Comments: 0 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B — SYSTEM INFORMATION (Continued) SKETCH OF SEWAGE DISPOSAL SYSTEM: INCLUDE TIES TO AT LEAST Two PERMANENT REFERENCES,LANDMARKS OR BENCHMARKS. LOCATE ALL WELLS WITHIN 100' /9' a' DEPTH TO GROUNDWATER: DEPTH TO GROUNDWATER METHOD OF DETERMINATION OR APPROXIMATION: - 6�Q . . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C — FAILURE CRITERIA (Indicate Y—yes N-no ND—not determined.Describe basis of determination.If"not determined",explain why not.) Backup of Sewage into Facility? l Discharge or ponding of effluent to the surface of the ground or surface waters? Static liquid level in the districution box above outlet invert? Liquid depth in cesspool, 6"below invert or available volume, 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal?cracked?structurally unsound?substantial infiltration?substantial exfiftration? tank failure imminent? Is any portion of the SAS,cesspool or privy, below the high groundwater elevation? Within 50 feet of a surface water? IV Within 100 feet of a surface water supply or tributary to a surface water supply? Within a Zone I of a public well? Within 50 feet of a private water supply well? Al Within 50 feet of a bordering vegetated wetland or salt marsh (cesspools&privies only, not the SAS)? 41 Less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,amonia nitrogen and nitrate nitrogen. PART D.— CERTIFICATION INSPECTOR: ROBERT J.BORTOLOTTI ADDRESS: 766 WAKEBY ROAD,MARSTONS MILLS COMPANY: BORTOLOTTI CONSTRUCTION INC. MA 02648 (508)771-9399 CERTIFICATION STATEMENT . I CERTIFYTHAT I HAVE PERSONALLY INSPECTED THE SEWAGE DISPOSAL SYSTEM AT THIS ADDRESS AND THAT THE INFORMATION REPORTED IS TRUE;ACCURATE AND:COMPLETE AS OF THE TIME OF INSPECTION. THE INSPECTION WAS PERFORMED AND ANY RECOMMENDATION REGARDING UPGRADE,MAINTENANCE AND REPAIR ARE CONSISTENT WITH MY TRAINING AND EXPERIENCE IN THE PROPER FUNCTION AND MAINTENANCE OF ON—SITE SEWAGE DISPOSAL SYSTEMS. CHECK ON . . . . , ,,. . . I HAVE NOT FOUND ANY INFORMATION WHICH INDICATES THAT THE SYSTEM FAILS TO ADEQUATELY PROTECT PUBLIC HEALTH OR THE ENVIRONMENT AS DEFINED IN 310 CMF 15.303. ANY FAILURE CRITERIA NOT EVALUATED AREAS STATED IN,THE'FAILURE CRITERIA"SECTION OF THIS FORM: I HAVE DETERMINED THAT THE SYSTEM FAILS TO PROTECT PUBLIC HEALTH AND THE ENVIRONMENT AS DEFINED IN 310 CMR 15.303. THE BASIS FOR THIS DETERMINATION IS PROVIDED IN THE"FAILURE CRITERIA"SECTION OF THIS FORM. INSPECTOR'S SIGNATURE ORIGINAL'TO SYSTEM OWNER,COPIES:BUYER(If applicable),APPROVING AUTHORITY TOWN OF BARJNSTABLE LOCATION I T�-�/�L .c>yl � C�----- SEWAGE# VTi LAGSP�►��f Ui��L�' �— ASSESSOR'S MAP &LOT O y�Co V#ft yg d:ER4 AME&PHONE SEPTIC TANK CAPACITY77;ii ff LEACHING FACILITY: (type) O S C (size) C� NO.OF BEDROO AUILDER OWNER C. ercl PERMITDATE: COMPLIANCE DATE: a_ Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility C>?// , Feet Private Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist Feet within3 "olh fac' ) Furnishedb Z�C' �� J - , �� �� �9' �� 2' I' �� � , � �P THE COMMONWEALTH OF MASSACHUSETTS a OFFICE OF THE ATTORNEY GENERAL W ONE ASHBURTON PLACE C I.� V 0 BOSTON;MASSACHUSETTS 02108 O,�M gV MARTHA COAKLEY (617) 727-2200 ATTORNEY GENERAL (617) 727-4765 TTY www.mass.gov/ago October 28,2010 Property Owner 1758 Falmouth St. Centerville, MA 02632 RE: Commonwealth v. John Duridas;Septic System Inspections --� Dear Property Owner, C-D o C On October 23, 2010, a Worcester County Grand Jury indicted Mr. John Duridas"I and he is currently being prosecuted by the Massachusetts Attorney General's office. We a�e�JontactillL you about this matter because the allegations against Mr.Duridas may directly or ind rectly ro impact the'property at 1758 Falmouth St. and because you may be interested in knov ing the u� progress of the pending criminal prosecution. co rn The Commonwealth alleges that between 2008 and 2009,while acting as a contractor for a realty company called Prudential Lenmar Realty,Mr.Duridas provided forged or otherwise invalid Title 5 septic system inspection reports in connection with the sale of homes being listed by Prudential Lenmar. The Commonwealth alleges that the inspection reports, either bearing John Duridas' name or the forged name of"Michael Tetreault,"were fraudulently provided. Although the validity of the inspection reports may be questioned,please be aware that there may not be anything genuinely wrong with your septic system. The allegations, if true, simply mean that your septic system was not properly inspected at the time the property was transferred. As an indirect victim of Mr. Duridas' alleged crimes,we want you to be aware of the status of the Attorney General's efforts to prosecute these offenses. Mr. Duridas will next appear in the Worcester Superior Court on Tuesday,November 2, 2010. At that time he will be arraigned and formally notified of indictments alleging: • Two (2)counts forgery • Two (2) counts violating the state environmental code • One (1)count of larceny by false pretenses over$250 (by scheme) • One (1) count of identity fraud If you have questions about the Title 5 report on your property, or the Title 5 requirements, please contact your local board of health. If you have any questions or concerns about this criminal prosecution,either at this time or while the case is proceeding,please do not hesitate to contact me. Sincerely, Ashley Cinelli,Advocate Victim Witness Assistance Division Direct Dial(617)963-2394 ( ti� c COMMONWEALTH OF MASSACHUSETTS. EXECUTIVE OFFICE OF ENERGY& ENVIRONMENTAL AFFAIRS lipDEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK IAN A.BOWLES Governor Secretary TIMOTHY P.MURRAY LAURIE BURT Lieutenant Governor Commissioner Title 5 Q&A Potential Questions Regarding Cases Where It is learned That The System Inspection Report Was Invalid. 1. Are current owners obligated to have the system inspected? DEP will not require that the current owner arrange to have the system inspected by a licensed inspector unless it is as part of a future property transfer. However; BoHs may also require that the system be inspected if it believes that the system constitutes an imminent threat. 2. Can owners use these reports in the future? The reports may not be.used for any matter requiring a formal Title 5 system inspection,such as property transfers, even if the inspection report was prepared in the last three years. 3. Current property owners may ask whether they have any legal recourse against former owners? Owners are advised to consult an attorney if they wish to explore their recourse. October 29,2010 This.information is available in alternate format Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDDN 1-866-539-7622 or 1-617-574-6868. MassDEP on the World Wide Web: http://www.mass.gov/dep �� Printed on Recycled Paper Health Master Detail Page 1 of 1 Logged In As: Tuesday, November 9 TOWN\miorandd Health Master Detail 2010 Application Center Parcel Lookup Selection Items .... _ Parcel Septic �- Perc well r Fuel Tank Parcel: 189-036 Location: 1758 FALMOUTH ROAD/RTE 28,CENTERVILLE Owner: MUTOM JASEN &BOARDMAN, ELIZABETH Business name: Business phone:l._ Rental property: r Deed restricted:F. Number of bedrooms : .... o Contaminant released: F. Fuel storage tank permit: 1 Save Parcel Changes M 1 Retum toL —--------- -— �_ __ _.. _._ ... .. _... _.. . .. Parcel Info Parcel ID: 189-036 Developer lot:LOTS 1 & Location:1758 FALMOUTH ROAD/RTE 28 Primary frontage:82 Secondary road: Secondary frontage: Village:CENTERVILLE Fire district:C-O-MM Sewer acct: Road index:0522 Asbuilt Septic Scan: 189036_1 Interactive map Town zone of contribution:AP (Aquifer Protection Overlay District) State zone of contribution:OUT Owner Info Owner:MUTOM 3ASEN &BOARDMAN, ELIZABETH Co-Owner: Street1:1758 FALMOUTH ROAD Street2: City:CENTERVILLE State:MA Zip: 02632 Country: Deed date:5/30/2008 Deed reference:22949/288 Land Info . Acres:0.43 Use: Single Fam MDL-01 Zoning:RC Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info Building N ,ear€3uil Gross AreaLivin g Area Bed rooms Bathroorrts 1 1930 2990 1105 2 Bedroo ms1 Full Buildings value:$132,800.00 Extra features: $3,000.00 Land value: $108,000.00 http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=... 11/9/2010 d�� �a� ; J/�/j AsBuilt Page 1 of 1 (/ �^ TOWN O(F,.�BARN'STABLE LOCATION 1CJ CG�`�"`OJ1`ti R J Cbk-)�rSEWAG�E## VILLAGE (A \�� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONENO. SCO C\ '�`tf SOK a ci',( Ontoc l SEPTIC TANK CAPACITY / l! V U G tiL , �� LEACHING FACILITY:(type)U HT G� —K�(stze � a,X'L X 4. NO.OF BEDROOMS OWNER PERMIT DATE: ��J k/O)r COMPLIANCE DATE: ri$ Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility ,mil Feet Private Water Supply Well and Leaching Facility(if any wells exist , on site or within 200 feet of leaching facility) JV A Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY r QIc.V� p m 0 Q CLto,A01A A F'�on'c Q -it Si q �,I tv.�.OrJk 17 Csc ray q At,p i http://issgl2/intranet/propdata/prebuilt.aspx?mappar-18903 6&se... 11/9/2010 e i L 1 r y \V 4Tf r� V lZL rb 77 CJI Ll t s� 71;-�If 7:-7 1---T-- `r {- 1in Ot Fv - �1"• �,;�r mot,,,,,�� -- .. ! - -'e i ! r- . i Mr v ,t I OF SEFr-t ; Y 57�r'l L (. ' _ O NOTES I 5W GALLUN SEPTIC TANK J i MODE: HOREY ST-150[+H-1la 1 I. All construction methods shall conform to the Title V (310 CMR 15.000)and the FINISHED GRADE TEST PIT DATA ,I1-11I I s f Barnstable Board of Health Regulations. i 71"DIA\ Performed By: Daniel B. Johnson , There are no known private or public wells within 150 feet/400 feet of the proposed 3 H 10 leaching field. The proposed leaching field is not within 100 feet of a wetland, nor is it Witnessed By: Donald Desmarais within 200 foot of a river front. ; �. T SCH 40 5 00 Date: May 9, 2008 r�40 t or �� t 4 1 I - >. 'The existing cesspools shall be pumped and backfilled with clean fill prior to installing ---- SEPTIC TANK TO MEET r 10> the new septic tank. a SCH 40 TEE r LIQUID LEVEL REQUIREMENTS OF j4J 73 3__.- , rKA7° (��BC� ' TP-1 (EL. = 99.2) uAS BAFFLE 310CMR ISM FOR Ti ctI 4. No changes are to be made in the field without the approval of the Boad of Health and the a TEE ETC. TIGHTNESS. c H GAPA ' N 98.5 A, 0" - 8" IOYR4/3 Sandy loam ' o � + to.a D�' 97.0 Bw, 8" - 2T' 10YR5/8 Loamy sand design engineer. ALL WALL S LE EW 3/GASKE TS 3 4` µALSHALLBE CAST IN PLACE OR o o "N i O o MEC-tANICALL'(p.l t 92.9 Cl.0 l 27 - 76 10YR5/4 Gravely coarse sand 5. The proposed leaching area is not designed for use with a garbage disposal. Remove any INSERTED AT FACTORY o o o COMPACTED 36 88.2 C2, 76" 432" 2.5Y7/2 Coarse sand CRUSHED :TONE ` a existing garbage disposal. STABLE LEVEL BASE No Observed GW .;/t'DtA ' 99+1 104 6 ~ : � . Contractor Dig Safe 72 hours prior to construction (800) 344-7233. All system EPTIC TANK DIMENSIONS. 1t7 ti LX S 8" W X S B"H I TP-. (EI.,. = 99.1) components to be covered by magnetic tape. z�• _ �T'' 1 p LLo� 98.8 A, 0" - 4" 10YR4/3 Sandy loam 7. Property line information taken from Deed Book 21940, Page 15 and Plan Book 440. � `" OISTR►BUTION BOX /Soo v Tk�K 97.2 Bw, 4" - 23" IOYR5/8 Loamy sand Plan 98. The septic plan is not to be used as a property line survey. �+ 'o P P P Pem MODEL SHOREY DO -3 • 9'*� � � SePr' L 92.4 Cl, 23" - 80" IOYR5/4 Gravely coarse sand r7���p /yy�� REMOVABLE COVER r 88.1 C2, 80" -132" 2.5Y7/2 Coarse sand l :CH 40 OUTLET ATERAL_S 9. Contractor shall verify all plumbing from existing structure will be connected to the new �- DISTRIBUTION BOX TO MEET HALL BE SET LEVEL FOR A 43 ! 9�t0 St"'�(r - - �� _-�� -�- vw- ��--__�~�-- -^ -� septic system prior to construction. If any existing plumbing exiting the structure is REQUIREMENTS OF 310CMA MINIMUM OF THE FIRST rwO 9� ► 9a+� �- - 9 \ 6,5- Pool PERCOLATION 'PEST DATA found to be different then that shown on the approved septic system plan, the contractor -MN32(WATERTIGHTNESS CTION. TC1. FEET AND CONNECTED t0 °) �1 S UCTION E�Cl. 2 EACH DISTRIBUTION UNE shall notit , the des( engineer and corrections to the septic design will be made, if z3' � Date: May 9, 2008 � g p � `�1T1I SOUR 5CH 40 PVC RPE H 't ' b applicable and cost estimate may also be modified. All internal plumbing shall he No. 'IF f%TLETS f h LEAN o�r connected to the new septic system, unless otherwise specified USED � g7�9 C Soil Class: Class I (0.74 G/SF) CiUSHE,O iTONE ;- 1/1" y " DIA. S TONE rO BE LES s Poa� 3 R o`' o i he leaching1 area is designed for hedrtxims (min.) per z I(1 ('MR 15.24(H 5) ____ ;TALL LEVEL BASE MECHANICALLY J I "OMPACTED 9 N 0 Perc Rate: < 2 MPI (TP-I) ` r,^E i It► I crrtity that on I 1/05 I have passed the -toil rvaluator examination I nppirived by the 'CM:1 GRADE '�OF�D=J'iUQW EASTING CONC.COER97.�S SCHEDULE OF ELEVATIONS ItirhatYtnent ofFilviontnental 1,mi"tion (�anti the tier atuwr analvAt. was 1vtfomlu+d its nu ` AMD of Wt1Ei00VAJLE{ �ovsE q ` e tryttttcil train11111, VXprrtt%V nr1%1 oXlWrlrtl4r Ilr.ac-III"I Ill till ('Rill 3EL0'W t3�tlt)PAQOF METAL CavE E*1St��ry �oP �/* cmisistrm with the49 j Inv. Out Foundation (existing) 96.5 I S 017 00 Inv. In Septic Tank 95.90 Inv. Out Septic Tank 95.65 i F+ 98,? Inv. of I" F.M. at House 97.00tit i t rue Date ; C � A' 9T"� Inv. In Septic Tank for I- F.M. 95.90 90 N F 1"/!*7yR_ ' S ,,.i Inv. In Distribution Box 95.25 1 1 1'he contractor shall verity that the stone used for the leaching field is tree of fines, dust, 3 3'L �- /a . 3 'w• x o,9-'N (ov ek A LL) 1 <I,AB I Inv. Out Distribution Box 95.08 i �0� �M f,���� _ C�' s r�4q ate. (see detail) and complies with the requirements of 310 CMR 1-5.247 (he stone shall CFR ,TE I - 1 '' ScH Inv. In Infiltrator 0 95.0 `A J/" Bottom of lntilttotor 9 not be used if it does not meet the above requirements. -r q �) /P4 a T' 12 Bottom of TP-I (No OW) 88 ,. u, f. J 90ft 1 Of TP•1 (No(3W) KA 1 i 36' v 12. Connect the existing 1" SCH 40 PVC pipe exiting the house (force main from the I O o o rl� p o 4 0 existing laundry)to the proposed 1" SCH 40 PVC pipe (new force main). Insulate the 4 entire new 1" force main pipe to prevent freezing in the winter. Install a 90 degree elbow f-- b'--�► o 0 within the inlet of the septic tank. Install as I" SCH 40 PVC pipe (elbow extension) 14" below the inlet invert of the septic tank. VARIANCE: LOCAL UPGRADE APPROVAL o o t� B�+t 4 S`N ,� p J O � D� i. Request variance to increase the depth of cover over the proposed leaching area from feet to 4 feet (max.) per 310 CMR 15.405(1 xb). Note that this variance is allowed pe rjLA rost / local Board of Health regulations with no Board oversight approved. I vE X l_ t4GN 'HiaN C4PAc tY q';cH �0 /2 Do�SIE %q DJ JBLE 4- rurq` CALCULATIONS w A; 4ED ?eA ST'9N F iS7-o N E 1 3 Bedrooms 110 GPD/Bedroom X 3 Bedrooms 330 GPD `r aJrH L Percolation Rate - < 2 MPI (TP-1) rG A <<� v _ Soil Class : Class I (0. 74 G/SF) -- ----- - 4 T he Hlgh Capacity $1daWIr1AK Chamber See Note 9 ham as ucvv µ•cnwwm PROPOSED LEACH ING AREA: 7cA&E �S jh�o•�rJ -�- Infiltrators : 38' L x 10.8'W x 0 . 91H j Side Area: 87 . 8 SF X 0 . 74 G/SF - 65.0 GPD 4 304 4 c -- p8 GLC�N oar ,Z�P�sEo ��� liv Bottom Area: 410 .4 3F x 0. 74 G/SF = 303.7 GPD - - _ - f / T-�K-E�1 DED P { Total I.eachin Ca Ga.�pF b2a�>E q pacify: 368. 7 GPD I� FFg 9.9, It �,4p ro &A+DE � � _ 99fj _ D� �� ape 3.8 /rnAr� 1 3s - -- - - 0 u E1�1 iTiN(� gS,6$ �S,1S 9S.00 I )5.190 �- , q � C) "� �sC� No1'Ll� (Nr' ,7A�TO 64' E6cN SM 1M 0.D I V J JP Y CON' (IAA �[ I Z 'N�' � ,NS ' yU Z� �l(�l•{ �,/¢ �q ! DAVISDAv1S OLD N� 9Zr- �v CAI1 Nf N SON- - >? ----. .. _. ' !' 8CAa a ' -►:rSO N��Jv^ c v, f ^ L. IL /0, � w,c a9N N,cc z i �.��E*�" �r CAOSS y Of ' 1*41 err r,:yNK Sr27/�� /Z+'V 'S1:� SI�PT�I � SYSrgr. l��It; (ONTli /� C7'b« leP, « O A V 5, y /CNAI/44,, dt + o U M . (t CTER- ,,, ,Nt•�� ,4 , . 4 E N E '.l r err L L E ~ -v SUBSURFACE SEWAGE DISPOSAL SYSTEM i 758 Falmouth Road,Centerville (Map 189, Lot 36) 4�.•t t7 8 l 1 y `� R � �.}�"�,.._.......,._....,,t._..,,..t�•v E N F � � �.`°.,-7`,I (- w_ RD 0 �> f�/D� WT * o��j SSCALE: APPROVED BY: UR.A WN _ RRVIsED gb Pre David Oliveri 0t00 p.rl0 0+'.20 0+'30 &+4o p�.So Ot60 0+)o 0+ 60 0490 /*0 0 ltio /�►d o G r- For: 949 Worcester Si, Natick, MA 01960 N /yea R / :i o I $ ' '' DRAWING NUMBER Domestic Septic Design, Inc. (508)477- / \ By: P.O. Box 831, Osterville, MA 02655