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Home My WebLink About0069 FOX RUN - Health 69 FOX RUN 4: r Centerville A= 227 - 157 ------------------ �J o2z UPC 12534 No.2�153LOR �srco�'� HASTINGS, MN i No. Fee AjD THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppliLAtlon for Misposal *pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No� Owner's Name,Address,and Tel.No. yl. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.rt)h-r e irq� ALL'1 SS69-431-i,-513 Type of Building: Dwelling No.of Bedrooms Lot Size 14TLsq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ! gpd Design flow provided `j �„ gpd Plan Date d( _� /o g Number of sheets f Q �/Revision Date 1� Title p��' 11�1 bt�i (. �l S Il� � �p pill1!x { �6<Iy Size of Sep c Tank f! Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) �s Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of t e Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boar o alth E S' ned Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued off --------------------- ------- Fee No. �r -2 t/' THE COMM6 WE`AL`TH OF MASSACHUSETTS Entered in computer:_ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 9pphiatlon for MispoSaY,*pstrtn Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System y D,Individual-Components Location Address or Lot Noo Owner's Name,Address,and Tel.No. f Assessor's Map/Parcel "�._ C� ( n ( I 1r\V(14 1,T- ' Installer's Name,Address,and Tel.No. _ Designer's Name,Address,and Tel.No. Type of Building: w Dwelling No.of Bedrooms- j Lot Size sq.ft. Garbage Grinder( ) Other Ttype oftBu ilding , , {1�titw No.of Persbns Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 340. 1 gpd Plan Date j I M21) Number of sheets Revision Date +....,. Title ralil "/C irt�� d&� t'Ro 1 '-,,— ► 2t( 19 ,,---- Size of Septic Tank �, Type of SSA S. 2 k (` (AdJ t 6h (t ( f (I A 12. Description of Soil A i A ` 11 K llt 11ela Nature of Repairs or Alterations erations(Answer when applicable) _jJA} % , [:I� qj� f d(�J t _b&b st >u. r 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 Zealth .y , i nL I s r s S geed r .."w,-em = D .e= at tJ 1 ?{" CJ~ 4- .. oil Application Approved by �` � 'Date Application Disapproved by Date for the following reasons �.4,. Permit No. -" Date Issued ✓ r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at 1 n �lC_ ,�. has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit Noa , dated 7 Installer 1 t)I 1 f raA _ .bj' Designer #bedrooms v . Approved design ow gpd The issuance of this permit shall not be construed as a guarantee that the system will function arse esigned. Date $ ( Inspector /' ,) r =r„ _ _ No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction 3pPrmit .Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at f,`� Fb and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be co/mp/leetteedwjithin three years of the date of this _ermit. Date // i/ Approved.b TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE A ESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) At (size) D NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility - Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Lea ' g Facility If any wetlands exist within 300 feet of lea in a ili Feet FURNISHED BY 3 , LA Cs �s 'l'€wn of Barnstable c l Regulatory Services I': B �) Richard V.Scali. Interim.Director k �\ MASS. 1639. ,G� Public: Health Division. M Thomas McKean,.Director I 200 Clain Street,Hyannis,MA 02601 Office: 508-86=-4644 l Fax: 503-790-0304 Installer cC Desixner Certification Form Date: 1311 Selvage Perrrait# 7idL4�ZL`1 b assessor's 11zp\'Parcel ,f e: l''1 C C Designer; l tn f Installer: l ui�!✓l' S Cav �` $� -., �_........_�� Address: 12 lc/ f,� '2 - a --- Address: Sc( C: ky r tdaLe MA o„ 31 ID .—.._ �_.�.�-. w ay tssted.a perm tt tq Install a date) ,nstaller) septic system at_(o 5 ' ,, C`n�, c, It�c p—..._ based on a design drawn by (ad.dress) /Pt dated. (desigt>er) 1. certify that the septic system referenced above was installed substantially acrordio to ttg the design w, hich may include minor approved changes suc as lateral relocation f the distribution box and/or septic tatalc. Strip out (,,,required) was inspected and the soil were found satisfactory. s _.....; T certify that the septic system referenced above was installed with tttajor chin{es I.i.e.greater than 10' Lateral relocation of the SAS or any vertical rclocaltion of anv com{x�'rtai�t of the septic spstenl) but in accordance with State k, Local Reg_>•ulatiiai.is. plan t�,isicxt or certitiecl as-bu11t by designer to foilorv, Strip oui (if required) vv��ts inspected and tlhe soils Were found sart.sfactory. _y .... 1. certify that the sys e"I rCferenced above was constructed in I'd , `:A approval. letters 01'appllcablc) with the tet!r:; * pEz Ii T. ....._ McENTEE ()nstal el 's Sigi—iatlti'C) luctytt. Np,35109 �.J => ctstis` (Designer's Signature) . (Aitix Designe. ere} _ PLEASE RETURN TO 13A.RNSTABL:T PUBLIC 3EALT-H DIVISION. CERTIFICA'I' ..OF CON11:1'.I,IANCE WILL. NOT 13� ISSU�I) C%tiTIL I3t�T'II ":PHIS F'ORIti'T 131111."f C'ARD _1RI RECEIVED BY"1liE 1iAIINST,�BI I Ptll3l:>IC :CAI AL,'i'[1 13TE iSDUN. ['HANK YOU (1:Sepii t1C$N?;11CYC1;1 ific.ation Form Revs-14-!3.doc Engineers note:This certificatlor,is limited to an as-built inspection of system components as installed prior to backfiil.The engineer did not-supervise construction of the syslam.The insta!lar assumes responsibility for aft materials,v,,orkmans.1 �achti!)ing to specified grades w th Proper compact on and setting dsers;Cot,ers as s`r.oarn on tkie design plan. t Town of Barnstable Inspectional Services Department BARNSTABLa MASS, � gr Public Health Division y ass. g. i639 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 7862. June 25, 2020 SCUDDER BAY INVESTMENT CORP 65 SCUDDER BAY CIRCLE CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 69 Fox Run, Centerville was inspected on 06/13/2020 by Mathieu Rebello, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360-20 h). You are ordered to repair or replace the septic system within two (2)years 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 PER ORDER OF THE BOARD OF HEALTH Thomas cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\69 Fox run Centerville.doc Town of Barnstable MA .039. ,�� Inspectional Services Department rfD MA'S s Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An "x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ❑ Structurally unsound septic tank or SAS ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) VofLeaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc r I , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sevliage Disposal System F&M -Not for Wluhtary As'sessiiients 69 Fox Run Property Address Y Scudder Bay Investment Corp.=65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is . required for every Centerville MA 02632 06/13/20 t page. Citylrown State Zip Code Date of Inspection r t Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Mathieu Rebello key to move your Name of Inspector cursor-do not N/A use the return Company Name key. 30 Norse Rd ,Q Company Address South Dennis MA 02660 City/Town State Zip Code few 774-722-0271 SI-14140 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 06/13/20 Inspecoo?s$ignatii-re Dafe 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.=65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exlfltration 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): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 15 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run 19-'YO Property Address Scudder Bay Investment Corp.=65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary (coat) 2) System Conditionally Passes(cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation Of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution MR is leveled ar replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further 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 faiiing to protect public MiWth, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (colt.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 f Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cost.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El 0 , Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form —` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If.they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health, ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run V Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: -- Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): gpd-185 Detail: 19-81,000 18-54,000. Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ui � Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is Centerville MA 02632 06/13/20 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A Grease trap present? ❑ Yes ® No Water treatment unit present? ❑ Yes ® No If yes, discharges to: N/A Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: N/A Last date of occupancy/use: N/A Date Other(describe below): NIA 3. Pumping Records: Source of information: N/A Was system pumped as part of the inspection? ❑ Yes ❑ No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: Septic tank distribution box soil absorption s ® P � stem P Y ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1984 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: N/A feet Comments(on condition of joints, venting, evidence of leakage, etc.): joints tight,proper venting, no evidence of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2'feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon tank Sludge depth: 911 Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 811 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? sludge judge 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 liquid level was slighty above the outlet invert.Tee's in place, septic tank is due for a pump t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 f c Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 7. Grease Trap(locate on site plan): Depth below grade: N/Afeet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): N/A Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): N/A 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: N/A Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): N/A Dimensions: N/A Capacity: N/A p �' gallons Design Flow: N/A gallons per day t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert N/A Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): d-box was not located due to leach pit being overfull/hydraulic failure t5insp.doc•rev.712WO18 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form -e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owners Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cons.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No` Alarms in working order: ❑ Yes ❑ No' Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): N/A * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: N/A Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ Teaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5ins .doc-rev.7 /p /26 2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 13 of 18 sP 9 P Y 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -Ilt 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 11. Soil Absorption System.(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): liquid level above inlet invert entering leach pit with clear signs of hydraulic failure and will need replacement 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form 1 - • Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System information (coat.) 13. Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 0 3_ A +0 6 +o I - 31 31 - a ` 1- 39 3 - 3 H y y - 40 y i t5insp.doc•rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 4/12/84 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: design plan shows test hole EL-100.9. with no groundwater enountered. Bottom SAS EL-104.9 Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Scudder Bay Investment Corp.-65 Scudder Bay Circle Centerville, MA 02632 Owner Owner's Name information is required for every Centerville MA 02632 06/13/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank_Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 as :;z ��- Commonwealth of Massachusetts F-t F Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rQ 'f 69 Fox Run Property Address Sharon Taylor ODD Owner Owner's Name ; information is Centerville ✓ MA 02632 12-26-17 1- required for 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 c // When filling out forms on the computer,use 1. Inspector: only the tab key to move your DOUGLAS A BROWN cursor-do not Name of Inspector use the return key. D.A.BROWN INC Company Name P.O. BOX 145 tLA Company Address CENTERVILLE MA 02632 City(rown State Zip Code 508-420-4534 S14297 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 lime 12-26-17 Inspectoroignature 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: At time of inspection this system met all minimum passing requirements. This report is not to be used for bedroom determination. This system is from 1984 and has seen very little water usage over at least the past 2 years. this report can not predict the future performance under the same or increased usage. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is Centerville MA 02632 12-26-17 required for every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form: 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y day flow t5ins•3/13 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 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 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•3113 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 M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 , every page. Cityrrown 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): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Fonn:,Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Fox Run Property Address Sharon Taylor Owner Owners Name information is required for Centerville MA 02632 12-26-17 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: according to design permit system consists of a 1000 gallon septic tank, d-box, and a 1000 gallon leach.pit. Number of current residents: 1 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 Seasonaluse? ❑ Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: 16-71gpd 17-73.9 gpd system is not designed for use with garbage disposal. Sump pump? ❑ Yes ❑ No Last date of occupancy: currently occupied Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1984 as per attached permit.#84-495 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 1.75 feet Material of construction: ®concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallon Sludge depth: moderate t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown 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 Scum thickness moderate Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? scour pole Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): If tank has not been pumped in the last 3 yrs I recommend pumping at time of transfer and every 2-3 yrs there after for maintenance. One of the supports for the deck stairway is directly over the center of the tank. I mentioned this to the Board of Health and they told me just to note it on the report and recommend re-locating it. 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 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. CitylTown 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-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 r . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 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.): Box was viewed by camera because we were un able to locate with measurements provided.lt may be partially or totally under the stone wall in the back yard. D-box appeared to be functioning properly at time of this inspection.This was also mentioned to Board Of Health. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Pit was located and opened and had approximately 14 inches of usable space at time of this inspection with no clear signs of failure or stainlines above that. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 every page. Citylrown 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.): I t5ins•3/13 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 M 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w„ 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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: no h20 at 12 ft feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: attached 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: Attached design plan. 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 69 Fox Run Property Address Sharon Taylor Owner Owner's Name information is required for Centerville MA 02632 12-26-17 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 '� -16 l Y r LOCATION EWAGE PERMIT NO. FOX RU w VILLAGE co V,,/, INSTALLER'S NAME i ADDRESS .4�5e� fir. e U I L D E R OR OWNER Fr ed 6 ► l 1 i�(F— Hv s . � DATE PERMIT 1 SUED DAT E COMPLIANCE ISSUED c 6-0 N w co Jlk- 1V �wV 2 Zy r4 � oQ � � � Q � � y I<tj W� p kk 041 0 1p ti w W K 14 V �a o ° � Q F44 u V � ' •°aefa � � °° Q;4� oo O y h � lo �1 \ � � � ' . . F . . . . � p � h v �0.4 'V � W �C � WI� 04, o a ri lk 14 14 ZW 4, lk �a s � � Vv, ETrsLn y O o 0 2' �z . w pttiQo � W aA � iWa � e N• h4�� v jVV � � 2 J �oZ� h W � � y it ski �� \ V F• Wtj LOUw a4 - a � Q � W W . Q7w 14 lkti F. h y 2 m00 NoIY .. .... ........................ THE COMMONWEALTH.OF MASSACHUSETTS BOARD OF HEALTH T.own......................o F..-..........Barnstable----------•---•---.....----.................. Appliration for Disvos ai Works Tonstrnrtiun Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ............... Qt...#1i?_...FAx ........................................ ........ erVi11>�r...Ma .......................................... Location_Address or Lot No. Anchor Buildi --_ o................................ ........ 6.5-EaIMG-IA-th••l ac ;•--b ann s__-----•---_____ Steve Zebel. Owner A dress a .......... ............. ._..... ... Installer Address Type of Building Size Lot----------------------------Sq. feet Dwelling—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ...r allQ}1_.._.._.... No. of persons____________________________ Showers ( 2) — Cafeteria ( ) Q' Other fixtures .._......•----•--•-•--•................................_...•--------••- W Design Flow...........55---------------------------gallons per person per day. Total daily flow____.________33D......................gallons. WSeptic Tank—Liquid capacityl_QQQ.gallons Length_$_:_('!____ Width_ '10''- Diameter________________ Depth..5_':$_.....-. x Disposal Trench—No_____________________ Width.................... Total Length.....................Total leaching area....................sq. ft. =r� Seepage Pit No------------- Diameter........6-'__.___. Depth below inlet......_6.'_________ Total leaching area.......22-6---sq. ft. Z.� Z�` ;��Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed b p%ldredge-•Engnee Date_____..11_-2 $1 y - 1 5' T,=sst Pit No. 1.2• __minutes per inch �Deptli,of;,Test Pit_1.2.'.......... Depth to ground waternane---_enCOuriterec n=. Gx, Test,Pit No'2 _ N -�nunutes per anch l Depth of Test Pit........ Depth to ground water......NIA.........-----------------------••-----•----•-------------••• - �" Descrip,'t<o of So 1 I2 .--------2-'_ ---------------------------------------------------------------------------------------- .....1.C�a. U) x ................................... ..._-...1Q' gAtl in...Y.e-lAw_..s2aad.-------•------•---••-•-----•--._..._.. VW ------•--•-•-•--...-------10 12 me d..._.White.._�ans tranes.__of_..grauel,� o wa t� a 12 ' „ Nature of Repairs or Alterations—Answer when applicable............................_................................................... . ...-•-•------••------•--------------•------------._...----•---........_......-----•---------------------------------••----•••----------•-•.....-•-•--•--•-•---••--........-••••--- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee (sm b h- oard of he th. Si ne --- •- • e Application Approved By....................................................... ............... _ . at Application Disapproved for the following reasons---------------•------•--------•-----------------•----------•-------------------•----- Date ..... •-------------------••-----------........._..••-----•••--; -------I'll-------.... ------....---------------------------•------------------------------•----------------------- Date JJPermit No.......................................................-- Issued_--------------------•--••--._...._••_... Date ............... -`- - ...� vvm.nv��•r�h6,�r7 VI^ MHDDA�.t-IUC�t� i`S BOARD OF HEALTH Y ........... 0 WTl...................OF........... �Y1" '( �C rtifiratr of f9aamptiFaltu THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by-- S 9e•.L ....................•--...---•- •--•-------••-•-----•------------------------------•--.....------- `� Installer at......LQ.t._ .uas ---------------------------•--•••--•--...--•---••-- , has been installed in accordance with the provisions of T ;LE 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit Nol- _-_ + --------•-- dated............................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE._.-•--•-•................ 2-/ G �....•-- l— ----_._... Inspector.--_---•. ' h • •-----•..............••-•-••--....__...._______..................•--- { THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH P r f .town.................oF...-....'Barnstable .........-•••.................................................N .................... FFj' i rrr aal nrk wan trnrtiDrn �erntit Permission is hereby granted..........i A� Yg Leb..... --. •-----•-- -- to Construct (X ) or Repair ( ) an Individual Sewage Dis osal S stem at No.--- ...... o-t-•--r�10. e==..:_:U 1, •0ente,_V�,l e_,.._ :ass y •---••------•--•••---•-----•................ Street as shown on the application for Disposal Works Construction Permit No._-___ Dated.................................. DATE- a Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS r LOCATION 11°uo W4 coSEWAGE PERMIT NO. fob /C� O �C RU `/= VILLAGE INSTALLER'S NAME i ADDRESS 1 B U I L D E R 0W- , OW N E R © Kcv . DATE PERMIT 1 SUED DATE COMPLIANCE ISSUED d N �l l+J as 4 `.!3... ........... . THE COMMONWEALTH-OF MASSACHUSETTS BOAR® OF HEALTH Town.................._0F.............Barnstable----------------.---------------------------- Appliration for Disposal Morks Tonstrnrtiun Vamit cal Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ......C�I� ervi lle,...Ma. ------------------------------------------ Location Address or Lot No. Anchor Build. --Q.0--------------•------•--------- -•--...'-6-5-F-almaUth---� ....Hyannis................ W Steve Lebel Owner A dress •---...... ••........ ....... Installer Address d Type of Building Size Lot............................Sq. feet U Dwelling—No. of Bedrooms..............3...........................Expansion Attic ( ) Garbage Grinder ( ) pa, Other—Type of Building ..rannh........... No. of persons............................ Showers ( 2) — Cafeteria ( ) W Other fixtures ................................. . d --••--------- ------------- --•------ ........ W Design Flow...........5.5...........................gallons per person per day. Total daily flow.-_......._..33D_.•..................__gallons. WSeptic Tank—Liquid'capacityl.QO.Q.gallons Length_$.'.('!.... Width.42_o". Diameter.-.__._.-___ Depth.5.':$_....... x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No--------...1....... Diameter........6.......... Depth below inlet.......6........... Total leaching area.......22-6..sq. ft. Z Other Distribution box ( ) Dosin tank ( ) Percolation Test Results Performed by ldredge._E2lgineering______________ Date...._... .-25-8.......__... a Test Pit No. ......minutes per inch Depth of Test Pit.1.2_'.__....... Depth to ground watern.s�n.e....eneountere 44 Test Pit No. 2----N7�_._minutes per inch Depth of Test Pit..._...NIA.... Depth to ground water------Nlk......... 9 .-----•---------------------------------------•----------------•--•-----•--........----..........---......................................................... 0 Description of Soil---------------Ll......----2-.-......l a m..&...to--s-e-i-l...--------------------------.:.------------------------------------------------------. x •--•--••---------------------------------------��••------10......med llil..Ye �.a�t sand--------•------------•-•------------•--••-----.......----------••------•--•- U � � ............................................10-.-------12-•-•-med.--..White.._sand/tranea---of---gx.aueal/na--•wa-te----at- 12 ' U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ------------------------------------------------------•----------------------...--•---......--•-------...------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in.accordance with the provisions of TITIL- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee (Slued b h oard of he th. Signe -- ••. - ` � _ ate ApplicationApproved By......................................................................... . Date Application Disapproved for the following reasons---------------••---------------------------------------•---•----------------•-----------------------------...... ••............................••--. ...------------------------------••--•-------••---------•-•------. Date PermitNo.......................................................- Issued....................................................... Date I _ No. .!.....t�L,.r ti Fss.._ �.. ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ......1.'-a-vm. .......................OF.............�arnstad l-e........_.._.............--•---..........._._. Apliliration for Dispati al Works Tontrurtion lirrutit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: 7 f, - n ....-----•---•-..__..--••• ....... .. Location-Address or-1 of"'No. E, ------------- zzchnr....al old-ullp�---ca-•-•------......_................ . . 6 lma> --� ��...i a �................. Owner /�f # 4, ddress W • M Installer Address Type of Building , , Size Lot............................Sq. feet a Dwell'n —j g <�No-" r . Bedroom rlo" 7�_____________3............................Expansion Attic ( ) Garbage Grinder ( ) p•I Otfxr Type of Building xB-=h............ No. of persons____________________________ Showers (2) — Cafeteria ( ) p-I Other fixtures ------------------------------•. - W Design Flow__....__._55............................gallons per person per day. Total daily flow-___._._____3.3D.......................gallons. WSeptic Tank—Liquid ca.pacit)10-00--gallons - Length$_!_6".__.. Width_4.._1.Q"_ Diameter________________ Depth _._ ....... x Disposal Trench—No_____________________ Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...........I........ Diameter-------6.......... Depth below inlet......6.......... Total leaching area......22.6...sq. ft. Other Distribution box ( ) Dosin tank ( ) z Wldred e---En�?neex�{_n .............. 1 -25-81 Percolation Test Results Performed by________________ ..c ... Date____...__._,_______.__________________-- Test Pit No. 1.22.,r{).......minutes per inch Depth of Test Pit_1_2_____________ Depth to ground water?!_QK!a---eXIICOU] f=, Test Pit No. 2....N/A_...minutes per inch Depth of Test Pit-------Ilti____ Depth to ground water..... vA .......... a •••••-----••-•••••••••-••••--••••••-••••--•••-•--•••••-•----••-•-•---•.............•------------•-••...................................................... 0 Description of Soil...............0:�-----...1 --__�0aRl-,&---t0}3SG-1--------------------------------------------------------•-------------•---•------------ ------------------------------------------•••--••-� --Q-�---mad iRua.-ye.] Low__.sand ------------------------------------------------------------------------ W ...........................................10----------1-z-•---mid-•----vlrb.i.1 e...aand/t .aaes---o•f---graval/no_-..water•_at-• 12. UNature of Repairs or Alterations—Answer when applicable_______________________________________________________________________________________________ -•-------------------•-----------....-----•-----•------------------------------------------------------------------------------------------------------•--------------------------------.............__. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITI-E 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed........................•----....._......__._...---......-•-•••--•-•--•••••••---••••-• ................................ Date ApplicationApproved By................................................................................................... Application Disapproved for the following reasons:-----•------------•---------------------••--------•----•--•--••---------..................................... ....................••-------•••-•----•-•....-_.._...--••••••------••-•-------••-•••--.....•••-----••-----••••-••-•--••--•---•--•-••----••••--------.-..-------------••••••-••••----•--................ Date PermitNo................................................... Issued_....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH 1'0wn...................OF..... arn.s 4ab�.. ................................................ TLFrrtifiratr of TompliFanrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed (X ) or Repaired ( ) by....S teWe._Lebel.............. ......................................... ........... .............................................................................................. 1 r „ Installer at..---eta_t._.�i:1C1.__.�.Q�w_. ]�1�.a---.. f; r�Ialle..----D'aa5..--------------------•-----------------•-----.._........_..._.._....---.._..----------------- has been installed in accordance with the provisions of T KE 5 of T State Sanitary Code as described in the application for Disposal Works Construction Permit Nog_-1".�_-•.,� __________ dated________________________________________________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................:................. .......... Inspector.........�-�............................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH '''own OF...................... _.....__.....---.........--------................••••••......_.. N ........................ FEIr.2).................. wiopos al Works 0-Punstrwtion amit Le Permission is hereby granted..........___teve_ bel .,............................................................................................................ to Construct X or Repair ( ) an Individual Sewage Disposal System at No....A_..__�D.. Ir1:0____.o__nun. Centerville, i�ass. -............................................................................. Street as shown on the application for Disposal Works Construction Permit No.___�__ Dated.......................................... .............. ......... ...... -------------------------------------------------------- Z Z Board of Health DATE.......... --------G�.. _...--------- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS t" Q o ZZ V OwV �J �J 1 lk 14 IA `l cc W�W • o go o a;o� phCam p\ �� 0W ° 2 .l CA nK� a ° � U v . Lo J , �, h o \ 4 ,f �o �. �� ova S It It 14 IL � ry0c � -41 04 14 Q py" tid , , e o 4 . ♦ ePD �0 h h ` O Z r o 0 tj U� tk � k � ETTS tk 20 0 Ski .� oo U) o h r Y o < 143 1: ti �. Aoc W "oww e� o � g � oca � � 4 , 14 Ink : I- � � a. J t 0 . QV �- w 0 I V� Ij V O Q V W v v :i wv14 -4w F5 3 ho � 18 -- EXISTING CONTOUR x 18.98 EXISTING SPOT GRADEo��O"Rtl ' 1/II PROPOSED WATER SVC. G EXISTING GAS SERVICE Ftd 1 TEST PIT t] o BENCHMARK LEGEND o a 069 Fox Run 12 min drive-home X FO RUN 40.8744 � �t�r 40.74 PK S'T E pF P_ N 39.71 $0.21 EDGE :..' `:=.r` UPE C9 r° a LOCUS MAP 6 /V WAY 03 8.4 Q- 37.70' .98 f / 34.37/ 35.70 35.05 x 34.65 / :32.94' 32.26 3 87 32.78 x 8.79 Sj �Q. 31.98 29.76 /25. 24.84 +23.36 2 79 2 EXISTING SEPTIC TANK 32 O ''29:8 x24. 6 8� 6' 26.29 +.21.as ` TOP OF TANK, EL.=14.30 O J v 24.69 93 \ INV.(OUT)=12.95f(VERIFY) Q1 �:•:r 24.16 \ 8 2 . 9(a: G n x oe ( EXISTING LEACH PIT 30 = � �: �" Za6 24.52` . ;'" ` 0 20V6 TO BE PUMPED, FILLED WITH 17.03 SAND AND ABANDONED 28.55 99 2 16 1 - _ 16.9 I C 0 28.38 24,31 �G. X 26.69 ExisnNc �� 0P � I I I .86 2 +24. 24.6 HOUSE(#69) �11 2 04X 3.19 BENCHMARK I I T.0.F.=25.Of 0' x 19.38 , TOP OF SONOWE I G' 1`o�� 1 0 ��f x 29.45 EL.=16.66 I 2 23.6 P�� S GS I DECK 1a.64 I I Itl 5.57�3.93 ,6 �+�19.3 � ICI �• / \ F / 21.82 I x 30.89 lal / 22. �1 1 9 STONEBND 21.00 J G +.19/34r,y \ , r 29.30 1 0 16.49 / 17.7V PROPOSED S.A.S. Is.so / 1 2-500 GALLON CHAMBERS \\\\ a-- /-- 16.26 SURROUNDED W/4' STONE x 1sy6 : T -2 J�\ 0122� 20 GB 15.78 15. 2• C� 4.91 X / X /J X 25. .� I AT 14.56 x 16.3 9 / GA 1 .02 x 16.34/~ V� 3' X 21. 4 / .! 17.89 X 29.1 1 3 ry rzl "z" Ae LOT 10 / ,3f,483 ±SF / ' / o �z� \ �' \ S.60 o PETER T. ?t� � McENTEE S CIVIL `n Al g `\ `\ No. 35109 'PfG1S1 `� '� � F � OWNER OF RECORD SCUDDER BAY INVESTMENT CORP -1 (yi 65 SCUDDER BAY CIRCLE CENTERVILLE, MA 02632 PARCEL ID: 227-157 Engineering by: SCALE DRAWN JOB. NO. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 1„=30' P.T.M. 205-20 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. 69 FOX RUN CENTERVILLE MA (508) 477-5313 7/8/20 P.T.M. 1 Of 2 Prepared for: Scudder Bay Investment Corp. 65 Scudder Bay Circle, Centerville, MA Y , NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE <12.50 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER & INSTALL RISER & COVER OVER ONE CHAMBER AND OUTLET AND SET TO 6' OF FINISH GRADE COVER SET TO 6" OF GRADE SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT TOF=25.Ot F.G. EL.=17.0t F.G. EL.=16.7t F.G. EL.=16.0t F.G. EL.=16.3 to 18.0tt CHARCOAL VENT L = 32' L = 5' 2" LAYER OF 1/8" TO 1/2" ® S=1% (MIN.) ® S=1% (MIN.) DOUBLE WASHED STONE 4"SCH40 PVC 4"SCH40 PVC (OR APPROVED FILTER FABRIC) 6" 00 10 l 1a^ 6 2' EFF. la 2' 3/4" TO 1-1/2" DOUBLE EXISTING 48" LIQUID DEPTH aaaaaaa WASHED STONE LEVEL ADD 4' 4.8' 4' GAS BAFFLE INV.=12.30 PROPOSED INV.=12.95t D-BOX INV.=12.13 EFFECTIVE WIDTH = 12.8' VERIFY H-20 INV.=12.00 EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN NOTES: H-20 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=13.1f .INVERTS, PRIOR TO INSTALLATION. BREAKOUT ELEV.=12.50 INV. ELEV.=12.00 as 2) -SEPTIC TANK & D-BOX SHALL BE SET LEVEL AND aaa0aaaaseaaa TRUE TO GRADE ON A MECHANICALLY COMPACTED aaaaaaaaaaa STABLE BASE OR SIX INCH AGGREGATE BASE, AS BOTTOM ELEV.=10.00 SPECIFIED IN 310 CMR 15.221(2). 4' 2 x 8.5' = 17' 4' 4' OF NATURALLY OCCURRING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = 25' 4) A GAS BAFFLE SHALL BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION BOTTOM OF TEST PIT, EL.=5.0 = SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: SOIL LOG DATE: JUNE 26, 2020 Ref.#TPT-20-124 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) BOARD OF HEALTH AND THE DESIGN ENGINEER. WITNESS: DONALD DESMARAIS (HEALTH AGENT) 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE Elev. TP- •I Depth Elev. TP-2 Depth LOCAL RULES AND REGULATIONS., EXCEPT AS REQUESTED BELOW: 17.0 A 0" 18.0 A 0" 310 CMR 15.405(b) - LOCAL UPGRADE APPROVAL LOAMY SAND LOAMY SAND 1) A variance to the 3' maximum cover requirement, for up to / 12"17 0 10YR 4 2 6' of cover over the S.A.S. Vented H-20 chambers specified. 16.2 B 10YR 4/2 10" B 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR LOAMY SAND LOAMY SAND TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10YR 5/6 10YR 5/6 DESIGN ENGINEER. 14.2 C1 34" 15.0 C1 ' 36" 4._ANY_CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING SANDY LOAM SANDY LOA FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN 5/4 ENGINEER BEFORE CONSTRUCTION CONTINUES. 13.0 C?OYR 5/4 48" 12.5 C2 tND 66" 5. ALL ELEVATIONS BASED ON BARNSTABLE G.I.S.t PERC 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 46"/54" THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. MED. SAND MED. SAND 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 2.5Y 6/6 2.5Y 6/6 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE 5.0 144" 7.5 126" DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY NO GROUDWATER OBSERVED PERC RATE 2 MIN/IN. ("C" HORIZON) THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING REFERENCE PEA: 12 MI 8IN P#2931,HORIZON) INCH CONSTRUCTION. / / / 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL, BE INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. c,F DESIGN CRITERIA ExisnNc NUMBER OF BEDROOMS: 3 HOUSE(#69)v�" T.O.F.=25.Oto� SOIL TEXTURAL CLASS: CLASS I t T �P DE51GN ;PERCOLATION RATE: <2 MIN./INCH DECK DAILY FLOW: 330 GPD DESIGN FLOW: 330 GPD O ti GARBAGE GRINDER: NO 16.89 LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF J .74 GPD/SF EXISTING SEPTIC TANK: 1000 GALLON CAPACITY M � A, PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-20 RATED N �, USE 2-500 GALLON LEACHING CHAMBERS IN SERIES ,"'PROP. SURROUNDED BY 4' DOUBLE WASHED STONE-ALL SIDES S A.S./� SIDEWALL AREA: 2(12.8 + 25.0') x 2' = 151.2 SF ` V� BOTTOM AREA: 12.8' x 25.0' = 320.0 SF TOTAL AREA:...................................................................471.2 SF DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.6 GPD SEPTIC LAYOUT Engineering by: SCALES DRAWN M 205 N20 PROPOSED SEPTIC SYSTEM UPGRADE PLAN Engineering Works, Inc. 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. 69 FOX RUN CENTERVILLE MA (508) 477-5313 7/8/20 P.T.M. 2 Of 2 Prepared for: Scudder Boy Investment Corp. 65 Scudder Bay Circle, Centerville, MA { t3'T d0A.4� sns ci i '038 31 a �,• "� � -L JO " L33N8 � � A //i/1j �SSd:N� S1NN`dJIN ; P� _� ,� J� �AA 'NO 133'1'!1S N IVW Z1k c r- _`tea S V W ' mot/ ._._�.,��/N d 0 / v---•- C-i r--- �A`dd 3 �!fl 2l33 N 10 N 3 ' 9MV1 ONINOZ 341 01 SWMOANOO '•1_ :�?rar7�3 � ONV1 1IAI0 NV1d SIH1 NO NMOHS ONI lltl - � 30MM - s T *ON QOf V31S193 03HUS194 03SOdOdd 3H1 IVMI AdI1b30 I ;. 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