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2130 FALMOUTH ROAD/RTE 28 - Health (2)
2130 Frlmouth Road/Routo 28, Centetwille� �... _ i t SYILG(LW ���QECYC(fpr0 UPC 12543 ' NOEL® HASTINGS. MN r ,. ,.. ._ .-... . yI _ ...,.. i�.�r�e . . ��. , e � ; �� � Y �. � � s �, ,�is � �_� �5� � � a WSWa s '• _ now € � ton '=+u oil z--' � sc t r �l No. l, Fee THE COMMONWEAL�HOF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftplitation for Mispo8al *pstrm Construction Permit Application for a Permit to Construct( ) Repair grade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot Nov/SO a Owner's Name,Address,and Tel.No Q A4W 001 Assessor's Map/Parcel — Installer's N.%y e,Address,and Tel.No. �� / rjf/G/' Designer's Name,Address,and Tel.No. Type of Building: l Dwelling No.of Bedrooms Lot Size ��J�76) sq.ft. Garbage Grinder( ) Other Type of Building 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 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) " Date last inspected: Agreement: Afn%,4- e�r,51 1 't e/lzwt 5 r/*o fTIJ� 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 /e'/ Date Application Approved by C Date �(D Application Disapproved by Date for the following reasons Permit No. a0 �� 0 L Date Issued /0 No. �� ! Fee ti THE COMMONWEAL TY,OF MASSACHUSETTS Entered in computer:. -PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppIicatiou for Disposal *pstem Construction Permit Application for a Permit'to Construct( ) Repair(4 pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. J aa�h Owner's Name,Address,and Tel.Nor dye.. D Uj A LO Assessor's Map/Parcel �6� - Installer's N e,Address,and Tel.No. /��i /����/' Desi er's Name,Address,and Tel.No. / Type of Building: Dwelling No.of Bedrooms Lot Size. sq.ft. ,,Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ( gpd Design flow provided�-fjl�; eigpd Plan Date Number of sheets Revision Date _Title t n ` Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable). Date last inspected: A j ptw,��d, 3- 1-0 - 15; t2 Agreement: � � 1451, ',e,17 ,1 51.,0 h �- N�rJ t 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 /i%% ,l„/l//` Date /C�2�7f> Application Approved by Date ��' ! Application Disapproved by Date for the following reasons Permit No. °t J Lit r Date Issued 3' /0 ---------------------------------------------------------------------------------------------------------------------------------------- ' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE;MASSACHUSETTS Certificte of Compliance THIS IS TO CE/RTIFY,that the On-ote.S,ewage Disposal system Constructed( ) Repaired( G)' Upgraded( ) Abandoned( )by //t✓/ �G�' �i/! athas been constructed in accordance 7 with the provisions of Tit e 5 and the fisposal Sy tem Construction Permit No. ' `I dated S " 10 Installer 7,22 �i Designer LL #,bedrooms /�Q/ Grp ,� Approved design^l�ow gpd The issuance oft,is permit shall not be construed as a guarantee that the system will functio afdesignZ Date ( l Inspector S 11 -----No. ptU f�.r-v�------------------------------------------------------------------------------------Fee 1 "�f r THE COMMONWEALTH OF MASSACHUSETTS r ` PUBLIC HEALTHDIVISION-BARNSTABLE,MASSACHUSETTS Bisposal.6pstrm Construction Vermit Permission is hereby granted to Construct( ) Repair -)'��_" Upgrade-( ) Abandon( ) System located at and u,described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with S TiLttl&5 and the following local provisions or special conditions. s: Provided:Construction must be completed within threeyegs of the date of this permit. Date 12— - /F - Approved by i `� 0 t-n DINING 1 O ROOM KITCHEN Q OFFICE v r m z w BATH LIVING BED ROOM BED BED ROOM ROOM ROOM FLOOR PLAN 2130' FALMOUTH ROAD CENTERVILLE, MA e 0:?'.-1 O--'2O 15 a 0 2 B:i19ax BOARD OF HEALTH RESTRICTIVE COVENANT OWNER: CP-SRMOF II 2012-A Trust,U.S.Bank Trust National Association, not in its individual capacity but solely as Trustee,with an address of c/o Selene Finance LP,9990 Richmond Ave.,Suite 400 South,Houston,TX 77042 the premises conveyed by said mortgage. PREMISES: 2130 Falmouth Road,Barnstable(Centerville),MA 02632 (� DATE: JAN'2 0 We;CP-SRMOF 112012-A Trust,U.S.Bank Trust National Association, not in its individual capacity but solely as Trustee,with an address of c/o Selene Finance LP,9990 Richmond Ave., Suite 400 South,Houston,TX 77042 and being show as Lot 2 on plan of land filed in Plan Book 281,Page,22,of the Registry of Deeds,for Barnstable County,entitled"Plan of Land in Barnstable Mass. for Evsun �+ Realty Trust,Scale 1 in 4..0 ft.Date Feb 10, 1974 Eldridge Surveying Co. 33 North Main Street,South Yarmouth,Mass 72A652" In cansidem ion_of-the-appro-yal of our application for a Disposal System Construction Permit by the Barnstable Board of Health, we hereby agree that the premises shall be restricted to no more than three (3)bedrooms,with the preapproved septic system. We further agree that this Restrictive Covenant shall be binding on our heirs, devisees and assigns. o� l J EXECUTED this day of"32r►u�20 j CP-SRMOF H 2012-A Trust,U.S.Bank Trust National Association, not in its individual capacity but solely as Trustee By: Selene Finance LP,Its attorney-in-fact By: Dan Shimmin Title: Senior Vie president *Officer of Selene Finance LP COMMONWEALTH OF TEXAS Wardo ss: On this _ 12V _ day oMa\uz — , 206before me, the undersigned notary public, personally appeared _ Dan Shimm n &nj&j ice Rresni_. � proved to me through satisfactory evidence of identification,which was. idebnaE own to be the person whose name is signed on the preceding or attached cument, and acknowledged to me that he/she signed it voluntarily for its stated purpose and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of(their)(his)(her)knowledge and belief. -a S'7.�'r_ yLA ' OAKEN "Sionr1.2.016 Notary Public My Commission Expires:0--ie BARNSTABLE REGISTRY OF DEEDS Jahn F. Meade, Register Town of Barnstable_ MIKE � Regulatory Services Thomas F 'Geiler Director • B,,RYsr,� Public Health„Div yQ' MASS. `0$ .- � _ ision AlEOMA�A + Titonl.is McKean;Dlrcctii"r" 20(1'Msiin:Strcet; Hyaiinis;"MA 02601 Office 50$. 86:-4644L "5 aO�3 08 790 6 . 4. I)atc: — _i Sc'vage;Pcritrlt# .Assessor's Map/Parcel' Iris""taller:Sc;1)es �ner Ccrtifcation Forrin jJ) 6 1. COrJGH llesigne_r htJt1 ✓iZ Installer: -lj-r Adiiress: 43. R PN&LL� Aiiilress; � (' xa was istiut d a hermit to, instal ' septic system aC 3�� (�`_ _ l` �Jt -_ lased on>a design drawn by ad'dress ' UI'D _ Cp(lC�"hf A.u7 iZ dated ,D.e4_ � 1 (designer) - __...- a. -- V [,ceiti ,y;that tlic septic system referenced above'was.installct}:Substantiallyt according to the design, which may Include nunor approved.ehangcs Suth ,as lateralxrclocation of.the distribution boy and/or septic tanl ; Stripout (if required) ��as Inspected and the soils were found satisfactory;. } e-ertify;:that the septic syslcm reicienced above was Installed with ma�or'changes {I e, gr.""eater t} an iq"lateral relocation,of the SAS or any ve rtle" Iclocation of any component` of the septic system) brut mti.c ordance with State & ducal Rc"i ations i Plan revswn or, certified as bailt by designer to tall6w SErlpout'(If rcq" t �Is ected and the soils found satisfactory ._.. _ A � CC3UTANQWt2, c ` (Installer s Signature) +,1/4- NL10�3 rf (Designers Sign,aria ) ,(Atll�i`I�e�Igncr's Stamp 1-ierc) PLEASE-RETURN TO BARNSTABLC PUBLIC.HEALTH DIVISION. 1.CERTIFI'CATE `OF'COMPLIANCE WILL.NOT= BE ISSUED ',:UNTIL BOTH =THIS FORM AND AS BUILT CARD ARE RECEIVED'BY.THE BARNSTABLE.`I'UBLLCHEAI TH:DIVISION., THANK YOU:r c�irillictt fomis\J�sign��ccrttlir:iiiun Iarii.Juc E TOWN OF BAR DNSTABLE LOCATION Q\2)O \MC)N,zh SEWAGE#. VILLAGE Q40T?-Q-'i \ ASSESSOR'S MAP&PARCEL p� INSTALLER'S NAME&PHONE NO. ink e(- SEPTIC TANK CAPACITY Rdo-'x C..k&Tf 0 c. � -p@'4or f ZlJ r30 LEACHING FACILITY.(type)' (size). 116,c 30 } f. NO:OF BEDROOMS f, OWNER -Skm Of ..Z 2-012 r A PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well, Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Y Edge of3- Oetland.and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Fv Feet - c - FURNISHED BY-1&41 wit V- s �` r .. yr, - _ - � . «�' .._°"ate. _ ���— toy ��r �5.` Town,of Barnstable Department of Regulatory Services t Public Health]Division M.tss. bate 200 Main Street,Hyannis MA 02601 ' rfFi hAA't k • Date Scheduled— A Time Fee Pd. Soil Suitability Assessmentfor Se age Disposal Performed-By:_D q LI A 114,0 W Witnessed By: LOCATION& GENERALINFORMATION Location Address ^ Owner's Name 213 0 �l1 kiov -k l�d ry el ' 644-,q1 e, 4�$�CJ�/�k OVA • Address 213d I �flrt /C7 Assessor's Map/Parcel: k (o (//� Engineer's Namc �Gt P I� Cff✓*hLf he hlr NEW CONSTRUCTION REPAIR Telephonefk Land Use `1e_511'1L tC,I [ wookot Slopes(96)_ Q Surface Stones Distance's from: Open Water Body o + ft-. Possible Wet Area J 0 +`ft Drinking Water Well [DV 4 ft Drainage Way 0 't' ft .Property Line l V t ft Other {t SIMI TCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands�n proximity to holes) r Y V M 7P,l N © C4ti Parent material is (geolo g ) ( ( D Depth to Bedroelp --d�� Depth to Groundwater. Standing Water in Hole: "' `� l,�f -� Weeping f1'om Pit Face �a he- Estimated Seasonal High Groundwater et 2A^S 3 &,ec p I!h 1 DETERMINATION FOR SEASONAL G]Ei WATER TABLE Method Used: rl►'k01`e r dJ ds7`1Mev► (�c 1�.�2 Depth Observed standing in obs.hole: > In, Depth to 5411 mottles: Dep)h to a ping from side of.�bQ.hole: iii, Groundwater AdjustiLr Index Well# �^ Reading Date: t i Index Well level A4 ft�ctor AC 1(0_ Adj.groundwater' vel �S3 .._ _ _... .. . PERCOLATION TEST Data 0,IO 1 it me Observation i Hole# _ Time at V Depth of Pere �ZI n Time at 6" Start Pre-soak Time @ v -06 Time(V-6") End Pre-soak _2- Rate Min./Inch ` Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) original: Public Health Division Observation Hole Data To Be Completed on Back----------- i ***If peicolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conseiivation Division at least one(1) week prior to beginning. Q:\SEPTICTERCFORM.DOC ]DEEP.OBSEI2VATION HOLE COG Hole# l Depth from Sol Horizon Soil Texture Shcl Color Soil Other Surface(k) (USDA) (Munsell Mottlin• ) g (Slnucture,.Stoncs;Boulders. onsistency %Urivel) -[� FILL (J�1�► 1 i) [) 2` Al C?)4P 1 I'i y��p RR b41A Sg�A R4/a Fri )6 e DEEP OBSERVATION MOLE LOG Hole# Depth from Sol]Hor'izon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. r onsistency %Graven 1 I L.t_. 12a-16 U . Ca"Av Loom W9 3/2 �JariP FplaW& 1 ej 2S -42 LeoHtr jyh� K S /6 Lp 42_ C Recum �'�44 I0 ' R JDEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (S"cture,Stones,Boulders. Con i to c G (DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.j (USDA) (Munsell) Mottling (Structure,Stotres;Boulders, Cons ten 6 Flood Insurance Rate Man: 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 per )ous m iterial exist in all dress observed tht pughout the area proposed for the soil absorption system? US If not, what is the depth of naturally occurring pervious material? Ceitification I certify that on ��� �1 q S (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 requireerd a e perience descriiW in�10 CUR 15.017. r Signature `Ct� ' Date QGf i �q- �pajHeF gssgcy �o DAVI[� o D. " COUGHANOWR QAS.HPTIC\PERCPORM.DO C �0 �'CENSE'0 p ,� EVALUF� ASSESSORS MAP Ndr t (r T GJ ' PARCEL N0: 1a NOJ...�°'.::..Z . / Fps... �..0...-•- THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TOWN OF BARNSTABLE Allp iratinn for Di-vipinial Workii Tomitrurtion ,11ermit Application is hereby made for a Permit C onstruct ( tLO Repair an Individual Sewage Disposal l System at: " ............ �...`�a....- -... ..__... ....._...0......... ........Ld" '.. 2_........................................................ L�cation :\ddn•ss or Lot No. --------------------- ------------------------------------------- --------------- --................................. ` O«ncr p _ Addres L$_................ �?5 �t _.t'�-c'------ 14 - - ..__�!�-M. S_ ........ Installer Address Type of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms-------------------------------- •........... Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------_--.-__ ---- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) d Other fixtures ------------------------------------------------------ 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...................... 44 Test Pit No. 2................minutes per inch Depth of Test Pit_--------------_ Depth to ground water-.---•...--.-----------. --•-••---••----•..............................•-•---•--•-•-•-•--•-----•-•---•-------------. ----•-----•----•----------•---..---- 0 Description of Soil--------- ---------•--------------------------------------------------------------------------------------------------------------- x U -------•--------•------------•-----•-•--•-••---------•------------••---•---•-•-•-----•-•------••---•-•--- ----------- w -- ---------------- • --•--------•••-•••--.._..---•----•--•--•-•------------•---•--------•-----•--•--------....... --------------------------------------- U Nature of Repairs or Alterations—Answer when applicable ...�T -. .\_i-----.-. 0.......... -. "Tk<?. ` " ------------------------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Enviro ental Code—The undersigned further agrees not to place the system in operation until a Certificate of Co lia e has been issue by the board of health. Signe 3 —`�J~ Dace Application.Approved B _ _. . .. .. ��%, - --------- ----7-^3 ._ ------ _.... .._....... Dare Application Disapproved for the following,reasons: ------------------------------------------------------------------------------------------ ----------------------------------- -------------------- ----------------------------,,i------------------------------------------------....-- __ ---------- No. 3 q Dare Permit `/.... ..�,......d'......... Issued .......77 ... .3_... ...l-r...._.....: Dace Dig oD s THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH x TOWN OF BARNSTABLE ,���1trtttiu�t fux ��i�iauuul �i uxk,� C�uat.��x�r�tu>n pxutt# Application is hereby made for a Permit t_ Construct (�PLer Repair an Individual Sewage Disposal System at: �d ...-.-.-..-. � : r dam" .... Location=Address or Lot No. — ..................•.... ------------•------------.................... ................................................... •---------------•--...--------•••----••----•- ncr — W O V� -- Addres } Installer " Address UType of Building: Size Lot. .........................Sq. feet Dwelling— No. of Bedrooms------------ --------------------------Expansion Attic ( ) Garbage Grinder ( ) 0,, 7 Other—Type of Building ------------ --------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures 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 ( ) aPercolation Test Results Performed by.......................................................................... Date.................................... Test Pit No. 1----------------minutes per inch Depth of Test Pi ---- Depth to ground water------------------------ G� Test Pit No. 2................minutes per inch Depth of Test Pit---.---------------- Depth to ground water.....-.................. --• )................................................................................-...........................p •-------------------------------t / Description of Sorb - --- ------------------------------------------------•-- .. ........................................................................... ... ........ ......`_`__ - i l ... ...................... ........................ .................................Frl ._____ ____ ..___.yy___----_---_•-----_. d....( U Nature of Repairs or Alterations Answer when applicable �T' - S, S f -- .---"t tiJ--{• k k ......... . 'lE;?! -5.---0.:""��".w"�.__... `s._r!.`. __o......_ I�_. lf.... Q_ -��. .__.ti... _ ......... ......... .................................... .. Agreement: R The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions .of TITLE 5 of the State Enviro ental Code—The undersigned further agrees not to place the system in Operation until a Certificate of Com lia>} e has been issued by the board of health. I--� - �v� g 3 �. Dare Application.Approved By ..... . �-------- ----- -----------............ --. ..--------------...._-------;----------------------- -- .... ........... f 1 Dare Application.Disapproved for the following reasons: ---------------:--------....._------------------------------------------------........:--------.._.------------------- ------ r -........... - - ..... ... -----^----..------------------------------------------------..----------------------------------------------.....- ...^ 1 �r -- ... .. j :........ e Perml No. 1 S" .. --- -------------- ------- T.. . ...... Dace THE COMMONWEALTHF MASSACHUSETTS f yr BOARD OF HEALTH TOWN OF BARNSTABLE Ter#ifi ate of Tvmyliacnre , THIS IS TO CERTIFY, That the Ind.(vidual Sewage Disposal System constructed ( ) or Repaired by In,11 - --- ------------------- ---------- --------------- has been installed in accordance with the provisions of TITI. Vohi,,e t �nvi nmental ode a ecrib in the application for Disposal Works Construction Permit No. ?-...� dated .�'.- !`''. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ...----....��...�+..•v.. �,7`p....... -------- Inspecto THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH /� TOWN OF BARNSTABLE VNo -----•-• FEE. . .................. Dispan, t1 uxku T tx wtt xntit " Permission is hereby grant d. ` ..............�� .1 ,�^.. " r?...._ _ _L.......................•--•-••--...........----•..._.... to Construct or Repair ( ) an Individual Sewage 8isposy System at No. .�. C�...... --,�!^ tt"` - :- ...... ? f.�? :4 1_..T `' --------------------- A. Street pp as shown on the application for Disposal Works Construction Per mit�o --—��ated___ -- p • �-- ----------- DATE.__-- __.�. 1. Board of Health FORM 36508 HOBBS Q WARREN.INC..PUBLISHERS CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) r; 11,E\;L/_�hereby certify that the application for disposal works construction permit signed by me dated f �1_17 � , concerning the property located at al ti,,,.�-� Q � �'� �j A meets all of the following criteria: �• There are no wetlands within 300 feet of the proposed septic system There are no private wells within 150 feet of the proposed septic system _ • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility I t` There is no increase inflow and/or change in use proposed- I There are no variances requested or needed. 1 � SIGNED : 1N1 i`---'-- -a._ 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]. LP r� o� Sfi e uD _____, 1./ 4 t e TO OF STABLE LOCATION 0 SEWAGE # 9�. 6 Y6 VILLAGE :� 1�- ASSESSOR'S MAP& LOT " / INSTALLER'S NAME&PHONE NO. (kf I rid SEPTIC TANK CAPACITY / — 16,60 AJ LEACHING FACILITY: (type) W %� T .. (size) NO.OF BEDROOMS .� BUILDER OR OWNER �Q�? ✓; te�.r�t _�L PERMITDATE: ` ' COMPLIANCE DATE Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility t Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) M V Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet eachi g facility N D. Feet Furnished by =tz� "107 ID- OY 4 0 AO o 3 � TOWN OF BARNST LE J LOCATION,/5�) /�'�/XSEWAGE # VILLAGE ASSESSOR'S MAP & OT INSTALLER'S NAME & PHONE NO. � . SEPTIC TANK CAPACITY LEACHING FACILITY:(iYPe) 3 a (size) NO. OF BEDROOMS - P IVATE EL R P BLIC TER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 1 z 13 a! VARIANCE GRANTED: Yes No c ��a t{/ _`, �, � r i ��' •� ,y -__—� sJ ti � f� ��b;; ®� � \ > �6�-�� � \�� � f -` � � I j � � � � f�/G` \5°� `� r -, _ ,._ J TOWN OF AI2 NST E LOCATION / Gc l '� WAGE # yILLAG,E - U .Ile ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACfI NG FACILITY: (tax) `h" lt (size) NO.OF BEDROOMS BYSILDER OR OWNER PERMITDATE: COWLIANCE DATE: Separation Distance Between the: / Ivlaximum Adjusted.Groundwater Table to the Bottom of Leaching Facility / , Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or`.vitWn 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet f leaching,fac}�) Feet Furnished by '7 r 0 © � _D_ 5 3 , a A_F_ q72 Q-c- g6'? A - - LW 16-F- 49 , F � r_r 0 rlo5 1' I r , Town of Barnstable Barnstable auewe� "Mg Board of Health j 4 (A,� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff, D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000, 2851 4266 August 11, 2014 Joseph R & Shannon E Chandler % Selene Finance LP % CP-SRMOF II 2012-A Trust US Bank Trust, N.A. 9990 Richmond Houston, TX 77042 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. Please advise us on the status of any repairs on the above-listed property and whether it is occupied or vacant. J PER ORDER O THE BOARD OF HEALTH Thomas McKean, R.S., CHO. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\2130 Falmouth Rd-Rte 28 Cent Aug 2014.doc ,*r • ------------------------------------------------------------------------------------------------------------------------- .BIKE Town of Barnstable Barnstable UAnwdtaCft * BARNSrABLE. : Board of Health MASS. I. F1659. � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff, D.M.D. `Juninichi Sawayanagi CERTIFIED MAIL July 24, 2013 b �� Mr & Mrs Joseph Chandler ccp 2130 Falmouth Road/Route 28 • Centervl e, RE: 2130 Falmouth Road, Centerville ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310.CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. • i I i Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc I` • I I ,A Please advise us on the status of any repairs on the above listed (2130 Falmouth Road/Rte 28,.Centerville, MA) property and, whether it is occupied or vacant. PER ORDER OF E BOARD OF HEALTH Thomas McKean, R.S., CHO. Agent of the Board of Health • • Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc I i • ---------- --------------------------------------------------------------------------------------------------------------- Town of Barnstable Barnstable aAsTA6 Board of Health 1111 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2850 7763 May 23, 2013 Shannon E. Chandler 30 Main Street Apt #13 Hyannis, MA 02601 RE: 2130 Falmouth Road, Centerville ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. Q:\SEPTIC\Letters Septic Inspection Failures or Future.Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc Please advise us on the status of any repairs on the above listed (2130 Falmouth Road/Rte 28, Centerville, MA) property and, whether is is occupied or vacant. PER ORDER:0FTHE OARD OF HEALTH la McKean, R.S., CHO. Agent of the Board of Health • QASEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc ry 4 Gar • -----—-------------------------------------- --------------------------------------------------------------------------- Town of Barnstable Barnstable Board of Health �Eora`. 200 Main Street, Hyannis MA 02601 I 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff, D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2850 7718 April 23, 2013 I I Shannon E. Chandler 2130 Falmouth Road/RTE 28 Centerville, MA 02632 • ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. i The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. System is in hydraulic failure. You are ordered'to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER E BOARD OF HEALTH omas McKean, R.S. CHO. Agent of the Board of Health I Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc a„4 �tMErh Town of Barnstable Barnstable Board of HealthAgAmedeaCft i639. p`0 ' 200 Main Street, Hyannis MA 02601 ( " RFD µ{d 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2843 2089 March 5, 2013 Joseph Chandler 19 Mockingbirds Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. • The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. , You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action: PER ORDER OF THE OARD OF HEALTH c ean, R.S., --0. Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc o i °FjME,°wy Town of Barnstable Barnstable ^ IIANSTAE7LE,Ft Board of Health- MASS,9 \LASS. �O, OMa 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7012 1010 0000 2843 1891 February 5, 2013 Joseph Chandier 19 Mockingbird Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. • The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P RDER OFT E BOARD OF HEALTH Thomas McKean, R.S., CHO. Agent of the Board of Health 5 Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[ Rt 28] Property Address Joseph Chandler Owner Owner's Name information is Barnstable[Centerville] Ma. 02632 12-19-2012 required for - every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Allan C.Taylor cursor-do not Name of Inspector use the return key. Canal Land Surveying and Permitting Inc. Company Name 306 Old Plymouth Rd. Company Address Sagamore Beach Ma. 02562 �nen Citylrown State Zip Code 508-888-5955 S12487 Telephone Number License Number B. Certification 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I Am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-4-2013/Report revised 2-14-2013 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. f t5ins-11110 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 2130 Falmouth Rd[Rt 28] Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria describe 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 component/(Y, the"Conditional Pass" section need to be replaced or repaired. The systen of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 septic tank(whether metal or not) is structurally unsound, exhibits sub ntial infiltration or exfiltration or tank failure is imminent. System will pass inspe/hc tank is replaced with a complying septic tank as approved by the Board of Healt *A metal septispection if it is structurally sound, not leaking and if a Certificate of Compliance innk is less than 20 years old is available. YND(Explain below): r t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[ Rt 28] Property Address Joseph Chandler Owner Owner's Name. information is Barnstable Ma. 02632 12-19-2012 required for [Centerville] every page. Cityrrown State Zip Code Date of Inspection B. Certification (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 III pass inspection if(with approval of Board of Health): broken pipe(s) are,replaced ❑ Y ❑ N ❑ ND(Explain belo ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain low): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Ex In below): ❑ The system required pumping more than 4 times a year tie to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Bo d of Health): ❑ broken pipe(s) are replaced Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) /Eaaluation is equired by the Board of Health: ❑ exist w i h require further evaluation by the Board of Health in order to determine if is fail g to protect public health, safety or the environment. • pass unless Board of Health determines in accordance with 310 CMR. that the system is not functioning in a manner which will protect public health, the environment: sspool or privy is within 50 feet of a surface water t5ins•11/10 Title 5 Official Insp ection 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 2130 Falmouth Rd[ Rt 281 Property Address Joseph Chandler Owner Owner's Name informarequired is Barnstable Centerville Ma. 02632 12-19-2012 required for [ � every page. Cityfrown State Zip Code Date.of Inspection B. Certification (cont.) 2. SYStull,Will f311 101111095 the 0012rd Of Mudith (and Public Wate, Supplivi, Of any) determines that the system is functioning in a X10Ofeet t protects the public h Ith, safety and environment: ❑ The system has a septic tank and soil absem (SAS)and SAS is within 100 feet of a surface water supply or tributary to ater supply. ❑ The system has aseptic tank and SAS ans within one 1 of a public water supply. ❑ The system has a septic tank and SAS ans i in 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the San 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 anal s, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and th resence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that n 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 ❑ Or 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[ Rt 281 Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown 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 design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the followin addition to the questions in Section D. Yes No >J ❑ ❑ the system is within 400 feet of a ace drinking water supply ❑ ❑ the system is within 2 eet of a tributary to a surface drinking water supply ❑ ❑ the system is ated in a nitrogen sensitive area (Interim Wellhead Protection Area—I ) or a mapped Zone II of a public water supply well If you have answere " es"to any question in Section E the system is considered a significant threat, or answered "y " In Section D above the large system has failed. The owner or operator of any large system co . ered a significant threat under Section E or failed under Section D shall upgrade the syst' n accordance with 310 CMR 15.304. The system owner should contact the appropriate r . t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[Rt 281 Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Citylrown 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•11/10 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 2130 Falmouth Rd[ Rt 281 Property Address Joseph Chandler Owner Owners Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: unknow 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 ears usage 2011=24000 g ( y g (gpd))" 2012=15000 Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date fo s. Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per d d) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes [I No Industrial waste holding tank ent? ❑ Yes ❑ No Non-sanitary a discharged to the Title 5 system? ❑ Yes ❑ No er metei;Feadingas, if available t5ins-11/10 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 , 2130 Falmouth Rd[ Rt 281 Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) East date of ~ 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): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 i Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2130 Falmouth Rd[Rt 28] Property Address Joseph Chandler Owner Owner's Name information is Barnstable Centerville Ma. 02632 12-19-2012 required for [ ] every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: tank installed 1976/ distribution box and infiltrators installed 1995 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 25"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.): Septic Tank(locate on site plan): 24" Depth below grade: feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years list, age: age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8'-6"x4'10" Sludge depth: 3" t5ins•11/10 Title 5 Official Insp ection 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 so''t 2130 Falmouth Rd[Rt 281 Property Address Joseph Chandler Owner Owner's Name information is [required for Barnstable Centerville Ma. 02632 12-19-2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cost.) Distance from top of sludge to bottom of outlet tee or baffle 29" ' Scum.thickness 4 Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 5-1/4" How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The concrete outlet baffle is breaking down,and there are indication of solids in the outlet baffel Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ ethylene ❑ other(explain): I Dimensions: Scum thickness Distance from top of sc to top of outlet tee or Jbaffle Distance fro ottom of scum to bpttom of outlet tee or baffle D -ef last Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Il _� U ILIC U v111G1dr inblieciivn rorm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[Rt 28] Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) liquid levels as related to outlet invert, evidence of leakage, etc.): } 7 right or Holding Tank(tank must be pumped at time of inspection)(loca 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(conditi of alarm and float switches, etc.): Yes Nn t5ins•11110 Title 5 offida! Fomc Subsudew Sewage DiWo System•pap 11 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 2130 Falmouth Rd[ Rt 28] Property Address Joseph Chandler Owner Owners Name information is required for Barnstable[Centerville Cille Ma. 02632 12-19-2012 ] every page. Cityrrown 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 1/4" in both outlets 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.): There is evidence off solid carryover in distribution box and liquid level above outlet invert; Pumps in working order: ❑ Yes ❑ No Alarms in working order: El Yes No Comments(note condition of pump chamber, condition of pumps and appu nances, etc.): Soil Absorption System (SAS) te plan, excavation not required): If SAS not located, explain w t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 12 of 17 L : Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 2130 Falmouth Rd Rt 28 Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 8 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.): no surface ponding , soil conditions damp Cesspools (cesspool must be pi imped as part of iRspsrtiop) (IoGa' Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of ruction l5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 : Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . ' 2130 Falmouth Rd[ Rt 28] Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[le Centerville Ma. 02632 12-19-2012 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of signs of hydraulic failure, level of ponding, condition of vegetation, etc.): } r t5ins-11/10 Title 5 Official Inspection Forth: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 .� 2130 Falmouth Rd[Rt 28] Property Address Joseph Chandler Owner Owners Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Cityrrown 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 iFA��n cu-cw R.0 P= •$A c l c>, %4*o-sE_ *6 A- ► #1 cotr� A GRAPE 1—I46 uSANt] GALLOW A- 3 s 47 8 t 2 TA14tc Ici76 ►Ilk IS'M. ioo4 Q _3 z �48 4 r � 2 _ 20 ' II 3 r>�s T u.�t3urto� fox t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 2130 Falmouth Rd[ Rt 28] Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every 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: 7-9' below S.A.Sfeet 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: 1995 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ®' Checked with local Board of Health-explain: reviewed permitting paper work and hand drawn sketch on record at B.O.H for new leaching system,in,1995 ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: Ma.G.I.S mapping system You must describe how you established the high ground water elevation: reviewed all the above imfomation and made comparisons on Ma.:G.I.S Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspectionform Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ti 2130 Falmouth Rd[ Rt 281 Property Address Joseph Chandler Owner Owner's Name information is required for Barnstable[Centerville] Ma. 02632 12-19-2012 every page. Citylrown 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 o t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 SECTIONSENDER: COMPLETE THIS . . ONDELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No ` Joseph Chandler 119 Mockingbird Lane MA 02648 3. service Type MarstOns Mills, ❑Certified Mail ❑Express Mail I ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Ye 2. Article Number 7 012 1010 0000 2843 1891 (Transfer from service label); PS Form.3811,February 2004 Domestic Return Receipt 102595-02-M-1540+ UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid USPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Town of Barnstable Public Health Division 200 Main Streety Hyannis, MA 02601 1 �F V.anw.v-7� � 0{.iME Tq� Town of Barnstable CERTIFIED MAILM Public Health Division —um aa�. ' 200 Main Street _ I I I U.SPAPOU -11 HYA POSTAGE --, � �iI NNIS,MA ntED 41P+� Hyannis,MA 02601 G2���FEB 13 1 AMOUNT G.'PT41 SENbfClCF I I _7012_ 1010 0000 2843 1891 - 6,11 000510-05) I Joseph Chandier 19 Mockingbird Lane Marstons Mi0s.-MA 02648- „lst'ATICE NIXIE 0,115 , DE 1 00 02 23 13 RETURN 1-0 .Z;E- lDER NOT DELIVERABLE AS ADDRESSED UNABLE TO FORWARD ii 2 BC: G ii6C914C)L9ZC3D ®772 Ea {{-d65$$ r3$-.Lg- 1. ➢ +'?;w kS, �» •$ ` i1➢ ii1�1➢ ➢h 1h 11 1➢l➢i➢➢�3a�9.1ullI �1313 61➢�� i�ilf.-l19./� _ �, ��' 'r . .�.. j .. � I ,. 1. ..w.. ,� r': ! �� I' t f 1 y . \ .,. _ � 7 I � f t . �,�, �` i j . _ � � - "� � .. !, '� ��' ._ - --� � . c= r �. 1. _ f 4 �. �'. IWKE Town of Barnstable Barnstable BAFL-is-[ABLE. • Board of Health _ 9 MASS. 4'Arf 639. m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 . Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED•MAIL #7012 1010 0000 2843 1891 February 5, 2013 Joseph Chandier 19 Mockingbird Lane Marstons Mills, MA 02648 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5. The septic system located 2130 Falmouth Road, Centerville, MA was last inspected on 12/19/2012, by Allan C. Taylor, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following. • System is in hydraulic failure. You are ordered to repair.or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. P RDER OFT E BOARD OF HEALTH Thomas McKean, R.S., CHO. Agent of the'Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\2130 Falmouth Rd-Rte 28 Cent Feb 2013.doc Commonwealth of Massachusetts Executive Office of Environmental Affairs Dept. of Environmental Protection One winter Street'Boston,Ma. 02108 •Total Gf,id D.E.P. Title V Septic Inspector P.O. Box 2119 Teaticket, MA 02536 WILLIAM F.WELD (508) 564-6813 Governor ARGEO PAUL CELLUCCI Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION,,FORM ! \ PART A t` 7\' CERTIFICATION l�� �7 Property Address: 2130 Falmouth Rd.Rt.28 Centerville Address of Owner:-- F E B 5 1998 - Date of Inspection: 213198 (If different) 9-4 .ems Name of Inspector: John Graci Gail Dietrick I am a DEP approved system inspector pursuant to Section 15.340 of Title%(310 CMR 15.000) Company Name,Address and Telephone Number: CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: x Passes This Inspection Is based on criteria dented In Title V Conditionahy Passes code 310 CMR 16.303.My findings are of how the system is performing at the time of the Inspection.My inspection does — Needs Fu er valuation By the Local Approving Authority not imply any warranty or guarantee ofthelongevltyofthe Fails septic system and any of Its components useful life. Inspector's Signature: Date: 213198 The System Inspector shall s mit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable and the approving authority. INSPECTION SUMMARY: Check A, B, C,or D: A] SYSTEM PASSES: x I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes, no,or not determined(Y, N, or ND). Describe basis of determination in all instances. If "not determined",explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Co7hpliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked,structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 0412787) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 0 Telephone(617)292-5500 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2130 Falmouth Rd.RL 28 Centerville Owner: Gail Dletrick Date of Inspection:213198 _ Sewage backup or.breakout or hlah.static water level observed.in.the distribution box is due to a broken. or obstructed pipe(s)or due to broken,settled or uneven distribution box.The system will pass inspection if (with approval of the Board of Health). Describe observations: broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced —The system required pumping more than four 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 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 the public health,safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE 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 APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public watersupply well. The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presense of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method usedto determine distance (approximation not valid) 3)Other D] SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage in facility or system component due to an overloaded or clogged SAS or cesspool. _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged cesspool. SAS is in hydraulic failure. (revised 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 2130 Falmouth Rd.Rt.28 Centerville Owner: Gail Dietrick Date of Inspection:213198 D]SYSTEM FAILS(continued) Yes No Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria: _ The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: 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) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (revleed 04127187) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 2130 Falmouth Rd.Rt.28 Centerville Owner: Gail Dietrick Date of Inspection:213109 Check if the following have been done-.YOU must indicate either"Yes"or"No"as to each of the following: ,c_ — Pumping information was requested of the owner,occupant,and Board of Health. x None of the system components have been pumped for at least two weeks and the and the system has been receiving normal — flow rates during that period. Large volumes of water have not been Introduced Into the system recently or as part of this inspection. x As built plans have been obtained and examined. Note if they are not available with N/A. x — The facility or dwelling was inspected for signs of.sewage back-up. x — The system does not receive non-sanitary or industrial waste flow. _x_ — The site was inspected for signs of breakout. x _ All system components, excluding the Soil Absorption System,have been located on the site. x The septic tank manholes were uncovered,opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge,depth of scum. x The size and location of the Soil Absorption System on the site has been determined based on — — The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Sub-Surface Disposal Systens. x _ Existing information. Ex. Plan at B.O.H. x Determined in the field(if any failure criteria related to Part C is at issue,approximation of distance is unacceptable)[15.302(3)(b)] (revleed 04127)97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 2130 Falmouth Rd.RL 28 Centerville Owner: Gall Dietrick Date of Inspection:213190 FLOW CONDITIONS RESIDENTIAL: d!bedroom for S.A.S. Design flow: 440 g•p• Number of bedrooms: 4 Number of current residents: 1 Garbage grinder(yes or no): No Laundry connected to system(yes or no): Yes Seasonal use(yes or no): Yes Water meter readings,if available:(last two(2)year usage(gpd): rda Sump Pump(yes or no): No Last date of occupancy: Na COMMERCIAL/INDUSTRIAL: Type of establishment: nla Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present:(yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) No Water meter readings,if available: Ns Last date of occupancy: nra OTHER:(Describe) Ns Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: Na System pumped as part of inspection: (yes or no)No If yes,volume pumped:0 gallons Reason for pumping: Na TYPE OF SYSTEM x Septic tank/distribution box/soil absorptions system Single cesspool Overflow cesspool Privy Shared system(yes or no).( if yes, attach.previous inspection records, if any) I/A Technology etc.Copy of up to date contract? Other: APPROXIMATE AGE of all components,date Installed(if known)and source Information: 1976(WMh a new SAS In 1996) Sewage odors detected when arriving at the site: (yes or no) No (revlesd 04127/97) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2130 Falmouth Rd.RL 28 Centerville Owner: Gail Dietrick Date of Inspection:20198 SEPTIC TANK: x (locate on site plan) Depth below grade: 2' Material of construction:x concreate_metal_FRP_Polyethylene_other(expiain) If tank is metal, list age o . Is age confirmed by Certificate of Compliance No (Yes/No) Dimensions: 1.e•6^H 6.7"w 4-10^ Sludge depth:t" Distance from top of sludge to bottom of outlet tee or baffle: 26" Scum thickness:2" Distance from top of scum to top of outlet tee or baffle:6" Distance form bottom of scum to bottom of outlet tee or baffle: 16" How dimensions were determined: measured Comments: II (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) Septic tank and all components are structurally sound and functioning property.Recommend pumping every one to two years. GREASE TRAP: (locate on site plan) Depth below grade: rda Material of construction: _concrete_metal_FRP_Polyethylene_other(explain} Dimensions: rda Scum thickness:rda Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle:We Date of last pumping;,, Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) rda BUILDING SEWER: (Locate on site plan) Depth below grade: 27 Material of construction:_cast iron x 40 PVC_other(explain) Distance from private water supply well or suction Iine:t— Diameter: 4• Qmments: (conditions of joints,venting,evidence of leakage,etc.) (revised 0427197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2130 Falmouth Rd.Rt.28 Centerville Owner: Gail Dietrick Date of Inspection:70198 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: rda Material of construction:_concrete_metal=FRP_Polyethylene_other(explain) Dimensions: rda Capacity: rda gallons Design flow: rva gallons/day Alarm level:_nla Alarm in working order?_Yes_No Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) nfa DISTRIBUTION BOX: x (locate on site plan) Depth of liquid level above outlet invert: Liquid islerelwM bottom ofpipe. Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box etc.) D$ox le structurally sound PUMP CHAMBER: (locate on site plan) Pumps in working order:(yes or no)No Alarms in working order(yes or no)_ves Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) rda (revised 041Y71871 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 2130 Falmouth Rd.Rt.28 Centerville Owner: CallDietrick Date of Inspection:213198 SOIL ABSORPTION SYSTEM(SAS):x (locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present,explain: nla Type: leaching pits,number: one leaching chambers,number:nla leaching galleries,number: nla leaching trenches,number,length: nia leaching fields,number, dimensions:nla overflow cesspool, number:n1s Alternate system: nla Name of Technology:_nra Comments:(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) System and all components are structurally sound and functioning properly. CESSPOOLS: (locate on site plan) Number and configuration: nla Depth-top of liquid to inlet invert: rJa Depth of solids layer: r9a Depth of scum layer: nla Dimensions of cesspool: nla Materials of construction: nia Indication of groundwater: nla inflow(cesspool must be pumped as part of inspection) nfa Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, etc.) rda PRIVY: (locate on site plan) Materials of construction: da Dimensions: rva Depth of solids: nra Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.) nra (revised 04r17197) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 2130 Falmouth Rd.RL 28 Centerville Gall Dietrick 213198 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references, landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) nnC AA (� 0 A6 y�6 Pape ! of 30. (revloed 04)7r19T) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 2130 Falmouth Rd.RL 28 Centerville Gail Dietrick 213199 Depth of groundwater 10 Please indicate all the methods used to determine High Groundwater Elevation:. Obtained from design plans on record. Observation of Site(Abutting property, observation hole, basement sump etc.) Determine it from local conditions Check with local Board of Health Check FEMA Maps Check pumping records Check local excavators, installers X Use USGS Data Describe in your own words how you established the High Groundwater Elevation.(MUST be completed) USGS maps and charts (revlsed04IIT19T) page 10 0[ 10 ► , TOWN OF ARNST E LOCATION y // Gc/ �a� WAGE # VIf I;AGE _ cal T�� 0 .'Ile ASSESSOR'S MAP&LOT INSTAL!-EWS NAME&PHONE NO. SEPTIC.TANK CAPACITY ITftc•t1 66 1 LEACHTNG-FACII.=:(typc) ..L v�lF� `�"�c�TmS (size) NO.OF BEDROOM Sr BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE Separation Distance Between tbe: Maximum Adjusted,Groundwater Table to the Bottom of Leaching Facility Feet -Private Water Supply Well and Leaching 1~acilit (If any wells exist on site or within 200 feet of leaching facility) 3 Feet_ Edge of Wedand and Leaching Facility(If any wetlands exist within 300 feet of leachin fact Furnished by Feet GPI le•�! � 0 go's 0 NOTES ALL UNSUITABLE SOILS ARE TO BE REMOVED" DOWN TO EL LS V A T§O NS UTILITIES .29 THE CLEAN MEDIUM SAND HORIZON, AND REPLACED WITH ELEVATIONS.SPECIFIED ARE INVERT ELEVATIONS !G 2 y CLEAN MEDIUM SAND.PER TITLES TO M OF PPE} EXPRESSED 1 DECIMAL FEE i(BOTTOM 1 R N T NE. ROAD Ut 28 WA LINE. LOCATION � 28 INSTALLER MAY MOVE VENT PIPE TO A DIFFERENT1 LOCATION. SEWER LINES OUT EXISTING WATER,GA 3"p� �, HO E i �� OU1H "L ' GATE OF LEACH FIELD TREE REMOVAL AT INSTALLERS DISCRETION. GAS LINE' o DISTANCES IN AS OVERHEAD WIRE-•o— FALM y ok �9�G DECIMAL FEET INSTALL 40 MIL ,POL METHYLENE BREAKOUT BARRIER . SHOWN. PUMCCHAMBER.IN 23.45 UTILITY A B P - °o�OQOQ 27 UMP CHAMBER OUT 23.20 NOT 1 59.6 623' I .� �20 D-BO T SCAOLE D BOX IN 27.40� X: OU �2 62.3. 54.8 4O MIL LEACHING .SYSTEM IN.: 27J8 � CENTERVILLE MA 3 91.4 84.4 POLY j �� BOTTOM OF LEACHING 26.53" I `4 89.6 89:4 LINER... 0 SOIL 3ID 26 REMOVAL PROPOSED SOI FINAL. k rH1s 1s A y AREA: CONTOUR ABSORPTION l , 24 •� COLOR SYSTEM -. . o P a —SEE DETAIL 4 1 : . — p •.� FOR INSTALLATION �Y. USE COLOR ON BACK o LOT A U FULL DETAIL IS BEST IS In . 15 1n APEA 31500 Sf f VIEWED IN OAK o. OAK FULL COLOR I AN t3OOK .281 PAGE .2 2 . . \(�5 PLAN \ a III AS_;R."MAP �69 PCL.18 OAR R 12 In 8 In �O OT I 3 P\ . . OWED OAKrn 2 o BEECH t�,Q 0� r•••• • 000000000000000000. . _ • � P � � /. I .......... OF Q' + SDpE e ® � I • N p p Is In OAK I EXISTING FAILED ` b 18 in II IoAK. �� � SYSTEMS24 /. 3 LEGEND _ 18 In OAK SEPTIC COMPONENTS , 0 PINE �— s $ p O " CHAMBER 1000 G AL r PUMP 1000 GAL. PUMMCHA BER �. IBU i, I Porr►n�c� TR *15Ar. T10®XOK SO"'I TEST PI 12 16 . OAK I I 1 �HOF,N;4, 9c tl+oFn+ass9c . SEWAGE DISPOSAL �' N SYSTEM -PLAN DAVID yGs DAVID yGs / 212 +— D. �`, D. �, -TO SERVE EXISTING DWELLING WR �+ COUGHANOWR H 2� L `�' �A SCALE I in 20 ft N 61 JOSEPH 81 SHANNON 0 o. 4 ; 28 CHANDLER . �' � Zp 40 N RECORD (NOW/FORMERLY) 29 ELEVATION rFci o qp _ o - A OWNERS OF 28.04 0. 1 I 20 SqN SOLI THIS PLAN IS INTENDED SOLELY.FOR INSTALLATION OF THE SEPTIC SYSTEM. .. 4��� (0� 13CCENTERVI LE, MAO � � , 2 D DEPICTED ON IT. FOR ANY OTHER CHANGES TO THE PROPERTY INCLUDING SPOT ON DESK I P.O. BOX 1265 PROPERTY ADDRESS PLACEMENT OF ADDITIONS. SHEDS, FENCES OR SWIMMING POOLS. OWNER _ PRI!\-.1 ON . I x 17. In PAPER SHOULD CONSULT WITH A MASSACHUSETTS REGISTERED LAND SURVEYOR: FOR k+ROPE.R SCALE Url s c I 204 WEST MA TE. DECEMBER 3, 2014 ST CHATHAM ��. 7 02669 DA 1 .. 508 364-0894 PD 1/2 IOEi= ETE-3878 SOIL TEST I� OG . . t "; 1000 G/� LLON SEPTIC T/1NK 1000 GALLON PUMP CHAMBER 110113AMI6UTION L60X MUCH DIMENSIONS AND DETAIL ELECTRICAL PERMIT NEEDED �. SOIL EVALUATOR: DAVID D. COUGHANOWR, ASE. 0461 FOR PUMP SYSTEM WITNESSED BY: DONALD DESMARAIS, HEALTH DEPT. . TANK TO BE PUMPED DRY AT TIME OF INSTALLATION NOT AND EXAMINED FOR STRUCTURAL INTEGRITY. INSTALL - GROUNDWATER ENCOUNTERED AT 138 In BUOYANCY. . l In Q TO TEST PIT PERC AT 62 in 2 MINRNCH IN C SOILS NEW PVC OUTLET TEE EQUIPPED WITH A GAS BAFFLE. CA L CSTAPER SCALE ELEVATION DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER REPLACE .WITH A NEW seasoNAL HIGH ® 12 In INCHES HORIZON TEXTURE fMUNSELU MOTTLES ISOO GALLON TANK I MIN 1 in GROUNDWATER = 21.53 e 26.55 0-16 FILL TAPER IF CRACKED, ROTTED BOTTOM OF OR OTHERWISE PUMP CHAMBER = 19.03 0 9 FROM -� 16-I8 O SANDY LOAM 10 YR 2/2 NONE FRIABLE COMPROMISED. DEPTH OF WATER �°D N TANK y ,n TO 18-20 E LOAMY SAND 10 YR 3/1 NONE FRIABLE DISPCACEo = 2so ft a %� o ,� Say O ? EXTERIOR DIMENSIONS OF 0 20-26 A LOAMY SAND 10 YR 4/6 NONE FRIABLE c UNIT = 8.5 ft x 4.83 ft 26-44 B LOAMY SAND 10 YR 5/6 NONE LOOSE c 8.5 x 4.83 x 2.5 = 103 cu ft 8 ft-6 in A E `� 6 in STONE BASE 22.88 � 4.. NOT 103 cu ft x 7.48 = 770 go/ \ 44-144 C MEDIUM SAND 10 YR 5/4 NONE LOOSE - TO 770 x 8 Ibi oI = 6160 # USE SHOREY PRECAST 21 /n 2 CROSS SECTION VIEW 14.55 '�°* YI In NC PUMP CHAMBER WEIGHS 8240 # ST-1000 H-10 IT 2 GROUNDWATER ENCOUNTERED AT )36 in TEST P e4 �� SCALE 2 MIN/INCH IN C SOILS u.� � Y A,"C \� PUMP CHAMBER WILL NOT FLOAT OR EQUIVALENT DEPTH SOIL USDA SOIL SOIL COLOR SOIL OTHER # { , /\O TANK TO BE CERTIFIED WATERPROOF ALL ELECTRICAL CONNECTIONS ELEVATION 8 +L 8 WATERTIGHT BY MANUFACTURER TO BE MADE OUTSIDE CHAMBER i INCHES HORIZON TEXTURE fMUNSELL) MOTTLES. ft-6 in A: { , 26.15 CONTROL PANEL TO CONSIST OF AUDIBLE AND VISUAL ALARM ON LEA /t,rU/L,/lI/ G STONE TO BE DOUBLE WASHED & 0-12 FILL INDEPENDANT CIRCUIT AND TO BE LOCATED OUTSIDE DWELLING. LL�LS/�14�U71 IIV" FREE OF IRONS, FINES & DUST. 12-16 O SANDY LOAM 10 YR 3/2 NONE FRIABLE INLET OU L 16-18 E LOAMY SAND 10 YR 4/1 NONE FRIABLE COVER C V R PASSINGUSE BARNESi S n1 SOLIDSUM0.4 HP, 115 V. 1750 RPM FIELD A�ENDS�ON� LOIN PIPE ENDS AND VENT. IT 18-25 A LOAMY SAND 10 YR 4/6 NONE FRIABLE 3 IN DROP PROVIDE 114 in INSTALL GUI CK COVER PIPE TO BE SCH. 40 PVC INSPECTION PORT W HIN 3 in 25-42 B LOAMY SAND 10 YR 5/6' NONE LOOSE � FLOW LINE WEEPHOLE TO DISCONNECT TO PERF PIPE AND TO SLOPE OF FINAL GRADE: 22.65 DRAIN PIPE AFTER COUPLER GRADE AT .005 ft/ft - O 14.65 42-138 C MEDIUM SAND 10 YR 5/4 NONE LOOSE 'BUILDING 10 in 4 T PUMP CYCLE INTO RISER..DING G' ,� D-B 0 -- GAS 1 STORAGE�= 500 G ,,. ., TO s. - - 48 in - � D BOX LIQUID GALLONS =• a DESIGN CALCULATIONS LEVEL BAFFL FROM WEEP m - N SEPTIC ALARM ON 24 in HOLE N 5d O DESIGN FLOW: 3 BEDROOMS X 110 GPD 330 GPO TANK p Z PUMP ON 16 in � 2f a t N CHECK SEPTIC TANK: 330 GPD X 2 DAYS = 660 GALLONS. . VALVE .T 2b !n STONE BASE IF NEW y USE EXISTING 1000 GALLON SEPTIC TANK IF IN PUMP OFF l2 in 5d i SOUND STRUCTURAL CONDITION: IF NOT. INSTALL SEPARATION BETWEEN INLET & OUTLET TEES NO LESS THAN LIQUID DEPTH NEW 1500 GALLON SEPTIC TANK. ---- - - ' DISTRIBUTION BOX: INSTALL UNIT DEPICTED BELOW. CROSS SECTION VIEW a 1" s ON SOIL ABSORBTION SYSTEM: DOSING 82.5 GAL/CYCLE 4 E , E = = CYCLES/DAY 30.0 ft THE LONG TERM ACCEPTANCE RATE FOR A CLASS ONE BUOYANCY CALCS STORAGE 500 GALLONS - 330 GPD REQUIRED DISCHARGE HOLES NOT SMALLER THAN SOIL WITH A PERCOLATION RATE BELOW 5 MINUTES (ND YES - PER INCH = 0.74 GALLONS- PER DAY PER SQUARE FOOT. SEASONAL HIGH GROUNDWATER .= 21.53 CROSS SECTION VIEW 3/8 In, NOR GREATER THAN 5/8 in. THE 30 ft x 20 LEACHING FIELD DEPICTED CAN .LEACH: BOTTOM OF SEPTIC TANK = 19.38 DEPTH OF WATER DISPLACED = 2.15 BOTTOM AREA (30 x 20) = 600 sq. ft. EXTERIOR DIMENSIONS OF UNIT = 8.5 ft x 4.83 ft -INSTALLER TO OBTAIN DISPOSAL WORKS PERMIT BEFORE SIDEWALL AREA =0 0 sa. ft. 8.5 x 4.83 x 2.15 = 88.3 cu. ft x 7.48 = 660 GAL N STARTING WORK TOTAL AREA = 600 sq. ft. 660 x 8 /b/ go/ = 5282 # -ALL COMPONENTS INSTALLED SHALL MEET THE MINIMUM ` FLOW CAPACITY = 0.74 x 600 = 444.0 gal/day SEPTIC TANK WEIGHS 8240#k O REQUIREMENTS OF MASSACHUSETTS TITLE .5 SEPTIC INSTALL A 30 ft x 20 ft x LEACH FIELD AS CONFIGURED SEPTIC TANK WILL NOT FLOAT CODE (310 CMR 15). BELOW. FLOW CAPACITY =. 444 gal/day WHICH .EXCEEDS -INSTALLER TO VERIFY LOCATIONS OF ALL UNDERGROUND THE 330 gal/day REQUIRED FOR A THREE BEDROOM DESIGN. T UTILITIES BEFORE EXCAVATING FOR SYSTEM. - -ECO-TECH ENVIRONMENTAL RECOMMENDS THE INSTALLATION O /� n O f1= E LOW FLOW FIXTURES &. APPLIANCES, AND PERIODIC PUMPING yy L PUMPING OF THE SEPTIC TANK: -SYSTEM IS NOT DESIGNED TO WITHSTAND VEHICULAR LOADING. TOP OF FOUNDATION ALL PIPE TO BE SCH. 40 PVC* DO NOT PARK OR DRIVE VEHICLES OVER SEPTIC SYSTEM. RAISE COVERS TO WITHIN AND TO PITCH- AT 1/8 in/ft MIN VENT EL = 27.77 +- 6 in OF FINAL GRADE PIPE 28.50 -4 ®-BOX I12 .in *PIPE FROM PUMP CHAMBER TO S�Op x • 1 ' 1 MIN D-BOX SHALL BE 2 In PVC WITH, TEE 27.51 THRUST BLOCKING AT BEND. OBSERVED GW 14.82 (TP-2) EXISTING ,. INDEX WELL. MIW-29 SEE DETAIL ON BACK oo� o oa 8 "o 0 0 00 0�or o $ ocolUo 0 00 0 ,.. 1000 GALLON 27.40 o 0 0000 0 4 o oo�,00 P oQf o 4 o o0 0 ooao 0000a o 0 000000 00 900 27.03 ZONE D EMST1NG 1000PROPOSED 6 in 27.23 ood000a00000aoo oa�oo�a00000ao,00000000.a�s �000 SEPTIC TANK 23.55STONE p 2 �\ M �p READING DATE OCT. 14. 2014 SEE DETAIL ON BACK EXISTING PUMP CHAMBER 23.20 BASE L�L�/�1CIf11WG REED 4J READING 9.71 -SEE DETAIL ON. BACK 4- ADJUSTMENT 6.71 23.80 23.45 27.18 ADJUSTED GW 21.53 6 in STONE BASE EXISTING 19.03 26,53 19.38 6 in STONE BASE 3-6 Ln XX ft ft ADJUSTED SEASONAL T 5 ft 23 ft HIGH GROUNDWATER 21.53 SEWAGE DISPOSAL SYSTEM PLAN 2130 FALMOUTH ROAD CENTERVILLE. MA DECEMBER 3. 2014 ETE-3878 PG 2/2