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0095 GOOSE POINT ROAD - Health
95 GOOSE POINT ROAD, CENTERVILLE A= 252 080 UPC 12534 �o- No.2_ 153LOR `�� s' HASTINGS, MN 4L; . No. _ Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in comp es PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS 0(ppriration for is aI 6pstem Construrtion Vermit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) omplete System ❑Individual Components Lo Mion Address or ot�N-ro. 9S �aos �91/vr�1� Owner's Name,Address,and Tel.No. asses o.�ap/Parcel -/�QP a i a_PU(01Pj f?d q 1 eve 1.6 le5 6 2- Installer' Name,Address,and Tel.No. D signer's Name,Address nd Tel.No. 72-t i� E)(Cq Yo-f r v n 609 —Lil7-�� 23 Vjel ea i Weer uvl I -5f) -,342- 5 Type of Building: Dwelling No.of Bedrooms 1 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 33 6 gpd Design flow provided gpd Plan Date z D l5 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: 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 Bo o alth. Signed, Date Application Approved by Date Z\ Application Disapproved by Date for the following reasons Permit No. 7-,"1, — 09 I Date Issued r Y. No. �� — V I Fee /UO i- -� THE COMMONWEA ITH OF MASSACHUSE I I S Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . Px� 2pp Yication foris aYipste»t constructionertttit Application for a Permit to Construct( ) Repair upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. 95' L7005 rc O/iY i ( Owner's Name,Address,and Tel.No. Assessor s Map/Parcel -�Q-p vZ 5 a �U rzlel �U 9 _ K., �- 5 0 6 2- Installer's Name,Address,and Tel.No. Designer's Name,Address;and Tel.No. i(CCj XQf I v(1 SUS Li 17 b(,53 1v."1�r(�2. C✓11�i ����f� 7 . Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq._ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3(� gpd Design flow provided gpd Plan Date z Z U I l5 Number-of sheets Revision Date Title Size of Septic Tank 1-UU Type of S.A.S. ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 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 Boar do alth. Signe Date, 2 Application Approved by Date ({ .2 l Application Disapproved by Date for the following reasons Permit No. 2 (5- 007 -7 Date Issued V / s -- - - - - -------------------------------------------------- - - _ -- _ -.- -------_----- - -- ----------------- 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 _.1 I� X.L n V CA �� 1 C)n at --1 5 Q(� . �(�I C l 't _fp has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.20() Oc17dated Installer ��aPQ (--I � L.E Q �t Designer DUV'�I (T � 1 ' 1 i�{,F11I #bedrooms�� Approved designx-flow. ! `3j(J gpd The issuance of thi permit shall not be construed as a guarantee that the system will (nc�h n a/s�designed. Date Inspector No. LIS � Fee (U` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction j3erinit Permission is hereby granted too/Construct( ) Repair( j Upgrade( ) Abandon( ) System located at (_- 006 P.?U ` 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 a completed within three years of the date of this permit. Date U' 1 / - Approved by 11 v r Y. No. �� — V I Fee /UO i- -� THE COMMONWEA ITH OF MASSACHUSE I I S Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . Px� 2pp Yication foris aYipste»t constructionertttit Application for a Permit to Construct( ) Repair upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. 95' L7005 rc O/iY i ( Owner's Name,Address,and Tel.No. Assessor s Map/Parcel -�Q-p vZ 5 a �U rzlel �U 9 _ K., �- 5 0 6 2- Installer's Name,Address,and Tel.No. Designer's Name,Address;and Tel.No. i(CCj XQf I v(1 SUS Li 17 b(,53 1v."1�r(�2. C✓11�i ����f� 7 . Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq._ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3(� gpd Design flow provided gpd Plan Date z Z U I l5 Number-of sheets Revision Date Title Size of Septic Tank 1-UU Type of S.A.S. ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 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 Boar do alth. Signe Date, 2 Application Approved by Date ({ .2 l Application Disapproved by Date for the following reasons Permit No. 2 (5- 007 -7 Date Issued V / s -- - - - - -------------------------------------------------- - - _ -- _ -.- -------_----- - -- ----------------- 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 _.1 I� X.L n V CA �� 1 C)n at --1 5 Q(� . �(�I C l 't _fp has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.20() Oc17dated Installer ��aPQ (--I � L.E Q �t Designer DUV'�I (T � 1 ' 1 i�{,F11I #bedrooms�� Approved designx-flow. ! `3j(J gpd The issuance of thi permit shall not be construed as a guarantee that the system will (nc�h n a/s�designed. Date Inspector No. LIS � Fee (U` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction j3erinit Permission is hereby granted too/Construct( ) Repair( j Upgrade( ) Abandon( ) System located at (_- 006 P.?U ` 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 a completed within three years of the date of this permit. Date U' 1 / - Approved by 11 v FROM :down cape engineering inc FAX NO. :15083629880 May. 20 2015 09:20AM P1 !Town of Banistable Regulatory Service,-�, Thomas F. Gefler,Director er.�asys� w�a Public Tleadth, dD*dRAou Thomas 1@�McKean,llDireptor 00 laig S`fi eet,HTRnzdu,MA 02601 (7:ffice, 508-862-464 4 Fax,: 50 8-790-6304 . , ;[xa�talflo;r�x�'�sa a^a•C:ex'>ti��aittnan�.�'aa�a ; Date: l� l� �Jr f�o;av�I�tC �e�rtgan$� zGl�_ 04� .,A.messor's MA-pllFyearest Z57.4 0 Desigiier .1J0N1�.._ C C i/ILLh :Hn7ts a�lltc�r: '.& 1/d O0 Address. �A i r— h,ddrem: 7 fAb I,, _ u4(- f-1 - On ^1'7�Q Zip�(,t�t O�Nay is�uEri.a pPrzn,t to in E�il1 a (date) - ..: (install,ez) septic system at 6" sjC Niel- based an a design.drLmn by (address) .._. I Ct',rt.ify that the S(ViG system,xeferenced above wm iuslnned mn.igtantt.ally^ acnorrli:ng'tu thu dpzip,Wbi,cli Ley'inpRide wLior approved changes suc.IL as .laferal.relocation of the distribution boy.ai.A/oz septic taldc. _ I erijify that the scptia ,ysteT.referenced abun. was iustafled Yn 'd:L majac n an.pp g oat('.1'tlan 1,0' latual xelocatian of,the SAS ox any, vtrtiral re-Incation of ony oomponalt of the ugtir uystem)bd in s.rr,,ordgum witli State Local Rr..nu(ati.ons. Plan r(Wisian. ar re�fifi.ed as-built by deli.)i,er to follow-, jt1 OF 41,15`�,c P6) DANIELA.8.11er°s;>ip�atu OJALA f.} CIVIL y No,46802 91 IONA (T1e;ign i' Si. z} tL�e) (Affix Desi ,?}ur's Stamp llexf-) k' , A ;'17ICT TiD—lfAi12BLE .f°9JBLiCD+Pdd,:t7�: tAl1�l,°;�dDi`1• ZE `,y l +t 4lTE_.. f) a d N6P�, dCF V►tii3.L iyr�, �!.3.D jj—kIJ, uO T,H 'Lkfb".. kiORM A.I�fJ� AfLBTT@y,T f AO ARE E Ck:04i-P.—IA&INST.ABLE,Y UBUC 112A ,'.H it3IV.4S.TOW, M&MU 7 01). n-v.nh}/:arrtin/IlNli bYiv.1'Or.rti Rcidirm Fo7m 1-.7&04.doa r Y. No. �� — V I Fee /UO i- -� THE COMMONWEA ITH OF MASSACHUSE I I S Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS . Px� 2pp Yication foris aYipste»t constructionertttit Application for a Permit to Construct( ) Repair upgrade( ) Abandon( ) omplete System ❑Individual Components Location Address or Lot No. 95' L7005 rc O/iY i ( Owner's Name,Address,and Tel.No. Assessor s Map/Parcel -�Q-p vZ 5 a �U rzlel �U 9 _ K., �- 5 0 6 2- Installer's Name,Address,and Tel.No. Designer's Name,Address;and Tel.No. i(CCj XQf I v(1 SUS Li 17 b(,53 1v."1�r(�2. C✓11�i ����f� 7 . Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq._ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3(� gpd Design flow provided gpd Plan Date z Z U I l5 Number-of sheets Revision Date Title Size of Septic Tank 1-UU Type of S.A.S. ' Description of Soil Nature of Repairs or Alterations(Answer when applicable) 4 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 Boar do alth. Signe Date, 2 Application Approved by Date ({ .2 l Application Disapproved by Date for the following reasons Permit No. 2 (5- 007 -7 Date Issued V / s -- - - - - -------------------------------------------------- - - _ -- _ -.- -------_----- - -- ----------------- 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 _.1 I� X.L n V CA �� 1 C)n at --1 5 Q(� . �(�I C l 't _fp has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.20() Oc17dated Installer ��aPQ (--I � L.E Q �t Designer DUV'�I (T � 1 ' 1 i�{,F11I #bedrooms�� Approved designx-flow. ! `3j(J gpd The issuance of thi permit shall not be construed as a guarantee that the system will (nc�h n a/s�designed. Date Inspector No. LIS � Fee (U` THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstent Construction j3erinit Permission is hereby granted too/Construct( ) Repair( j Upgrade( ) Abandon( ) System located at (_- 006 P.?U ` 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 a completed within three years of the date of this permit. Date U' 1 / - Approved by 11 v FROM :down cape engineering inc FAX NO. :15083629880 May. 20 2015 09:20AM P1 !Town of Banistable Regulatory Service,-�, Thomas F. Gefler,Director er.�asys� w�a Public Tleadth, dD*dRAou Thomas 1@�McKean,llDireptor 00 laig S`fi eet,HTRnzdu,MA 02601 (7:ffice, 508-862-464 4 Fax,: 50 8-790-6304 . , ;[xa�talflo;r�x�'�sa a^a•C:ex'>ti��aittnan�.�'aa�a ; Date: l� l� �Jr f�o;av�I�tC �e�rtgan$� zGl�_ 04� .,A.messor's MA-pllFyearest Z57.4 0 Desigiier .1J0N1�.._ C C i/ILLh :Hn7ts a�lltc�r: '.& 1/d O0 Address. �A i r— h,ddrem: 7 fAb I,, _ u4(- f-1 - On ^1'7�Q Zip�(,t�t O�Nay is�uEri.a pPrzn,t to in E�il1 a (date) - ..: (install,ez) septic system at 6" sjC Niel- based an a design.drLmn by (address) .._. I Ct',rt.ify that the S(ViG system,xeferenced above wm iuslnned mn.igtantt.ally^ acnorrli:ng'tu thu dpzip,Wbi,cli Ley'inpRide wLior approved changes suc.IL as .laferal.relocation of the distribution boy.ai.A/oz septic taldc. _ I erijify that the scptia ,ysteT.referenced abun. was iustafled Yn 'd:L majac n an.pp g oat('.1'tlan 1,0' latual xelocatian of,the SAS ox any, vtrtiral re-Incation of ony oomponalt of the ugtir uystem)bd in s.rr,,ordgum witli State Local Rr..nu(ati.ons. Plan r(Wisian. ar re�fifi.ed as-built by deli.)i,er to follow-, jt1 OF 41,15`�,c P6) DANIELA.8.11er°s;>ip�atu OJALA f.} CIVIL y No,46802 91 IONA (T1e;ign i' Si. z} tL�e) (Affix Desi ,?}ur's Stamp llexf-) k' , A ;'17ICT TiD—lfAi12BLE .f°9JBLiCD+Pdd,:t7�: tAl1�l,°;�dDi`1• ZE `,y l +t 4lTE_.. f) a d N6P�, dCF V►tii3.L iyr�, �!.3.D jj—kIJ, uO T,H 'Lkfb".. kiORM A.I�fJ� AfLBTT@y,T f AO ARE E Ck:04i-P.—IA&INST.ABLE,Y UBUC 112A ,'.H it3IV.4S.TOW, M&MU 7 01). n-v.nh}/:arrtin/IlNli bYiv.1'Or.rti Rcidirm Fo7m 1-.7&04.doa FROM :down cape engineering inc FAX NO. :15083629880 May. 20 2015 09:20AM P1 !Town of Banistable Regulatory Service,-�, Thomas F. Gefler,Director er.�asys� w�a Public Tleadth, dD*dRAou Thomas 1@�McKean,llDireptor 00 laig S`fi eet,HTRnzdu,MA 02601 (7:ffice, 508-862-464 4 Fax,: 50 8-790-6304 . , ;[xa�talflo;r�x�'�sa a^a•C:ex'>ti��aittnan�.�'aa�a ; Date: l� l� �Jr f�o;av�I�tC �e�rtgan$� zGl�_ 04� .,A.messor's MA-pllFyearest Z57.4 0 Desigiier .1J0N1�.._ C C i/ILLh :Hn7ts a�lltc�r: '.& 1/d O0 Address. �A i r— h,ddrem: 7 fAb I,, _ u4(- f-1 - On ^1'7�Q Zip�(,t�t O�Nay is�uEri.a pPrzn,t to in E�il1 a (date) - ..: (install,ez) septic system at 6" sjC Niel- based an a design.drLmn by (address) .._. I Ct',rt.ify that the S(ViG system,xeferenced above wm iuslnned mn.igtantt.ally^ acnorrli:ng'tu thu dpzip,Wbi,cli Ley'inpRide wLior approved changes suc.IL as .laferal.relocation of the distribution boy.ai.A/oz septic taldc. _ I erijify that the scptia ,ysteT.referenced abun. was iustafled Yn 'd:L majac n an.pp g oat('.1'tlan 1,0' latual xelocatian of,the SAS ox any, vtrtiral re-Incation of ony oomponalt of the ugtir uystem)bd in s.rr,,ordgum witli State Local Rr..nu(ati.ons. Plan r(Wisian. ar re�fifi.ed as-built by deli.)i,er to follow-, jt1 OF 41,15`�,c P6) DANIELA.8.11er°s;>ip�atu OJALA f.} CIVIL y No,46802 91 IONA (T1e;ign i' Si. z} tL�e) (Affix Desi ,?}ur's Stamp llexf-) k' , A ;'17ICT TiD—lfAi12BLE .f°9JBLiCD+Pdd,:t7�: tAl1�l,°;�dDi`1• ZE `,y l +t 4lTE_.. f) a d N6P�, dCF V►tii3.L iyr�, �!.3.D jj—kIJ, uO T,H 'Lkfb".. kiORM A.I�fJ� AfLBTT@y,T f AO ARE E Ck:04i-P.—IA&INST.ABLE,Y UBUC 112A ,'.H it3IV.4S.TOW, M&MU 7 01). n-v.nh}/:arrtin/IlNli bYiv.1'Or.rti Rcidirm Fo7m 1-.7&04.doa FROM :down cape engineering inc FAX NO. :15083629880 May. 20 2015 09:20AM P1 !Town of Banistable Regulatory Service,-�, Thomas F. Gefler,Director er.�asys� w�a Public Tleadth, dD*dRAou Thomas 1@�McKean,llDireptor 00 laig S`fi eet,HTRnzdu,MA 02601 (7:ffice, 508-862-464 4 Fax,: 50 8-790-6304 . , ;[xa�talflo;r�x�'�sa a^a•C:ex'>ti��aittnan�.�'aa�a ; Date: l� l� �Jr f�o;av�I�tC �e�rtgan$� zGl�_ 04� .,A.messor's MA-pllFyearest Z57.4 0 Desigiier .1J0N1�.._ C C i/ILLh :Hn7ts a�lltc�r: '.& 1/d O0 Address. �A i r— h,ddrem: 7 fAb I,, _ u4(- f-1 - On ^1'7�Q Zip�(,t�t O�Nay is�uEri.a pPrzn,t to in E�il1 a (date) - ..: (install,ez) septic system at 6" sjC Niel- based an a design.drLmn by (address) .._. I Ct',rt.ify that the S(ViG system,xeferenced above wm iuslnned mn.igtantt.ally^ acnorrli:ng'tu thu dpzip,Wbi,cli Ley'inpRide wLior approved changes suc.IL as .laferal.relocation of the distribution boy.ai.A/oz septic taldc. _ I erijify that the scptia ,ysteT.referenced abun. was iustafled Yn 'd:L majac n an.pp g oat('.1'tlan 1,0' latual xelocatian of,the SAS ox any, vtrtiral re-Incation of ony oomponalt of the ugtir uystem)bd in s.rr,,ordgum witli State Local Rr..nu(ati.ons. Plan r(Wisian. ar re�fifi.ed as-built by deli.)i,er to follow-, jt1 OF 41,15`�,c P6) DANIELA.8.11er°s;>ip�atu OJALA f.} CIVIL y No,46802 91 IONA (T1e;ign i' Si. z} tL�e) (Affix Desi ,?}ur's Stamp llexf-) k' , A ;'17ICT TiD—lfAi12BLE .f°9JBLiCD+Pdd,:t7�: tAl1�l,°;�dDi`1• ZE `,y l +t 4lTE_.. f) a d N6P�, dCF V►tii3.L iyr�, �!.3.D jj—kIJ, uO T,H 'Lkfb".. kiORM A.I�fJ� AfLBTT@y,T f AO ARE E Ck:04i-P.—IA&INST.ABLE,Y UBUC 112A ,'.H it3IV.4S.TOW, M&MU 7 01). n-v.nh}/:arrtin/IlNli bYiv.1'Or.rti Rcidirm Fo7m 1-.7&04.doa 04-23-15;03:14PM;From: Tc:15087906304 ;7744137476 # 2/ 2 Apr 01 2000 10:44PM GreenGnerealtyNYC.com , 6465247677 page 2 01 D+t 23-15;D2'39PM;Fran: *_r To 164roW47677 ;774037476 M 31 3 Town 0# lao rnstable Regalat?.ry Services Rirbard Y.Scali, iterim Director e Public FC i aitlt DIvlSIb11 Thomas eK n,Director cq �� z00 Maio Strw Hyarutis,MA 026011 fat; Soft-79D-6304 Ofrica- 508-262-46" Ham wner Certi cation nr for AtWrnative v trams Property Address: q. Assessor's 1Map\Pa e.rod: o7s Pa.-c u Property Owner$N:jn%a:154 e-V e- -L�(-050- in uccordtirut with Massachusetts DEP alternate Ik�e s�stem approval letters, the following certification information is required by the Owner of rccotlt The Owner of record must place an "x' in the applicable box next tocz line witifying dhe i0 nnation. Ye AA ❑ I leave bCrrn provided a eopy of the Title 5 Io A technology Approval letters. (16 paoc Standard Conditions k[ter and[ljc specific Rccllgaingyr letter) f 1 We been provided with dto Owner's�0 UR1 ❑ ® l have bwn provided with the Operatio and Maintenance Manual ❑ For Systems installed under a Rcmedis Us Approval,I agree to fulfill my seSppnsibilitics to provide a Deed Note a aS roquired by 310 CMR 15.257(10) and the Approval ] For systems installed under a Rernedial Us Approval,I agree to fulfill my respansibilities to provide written notific91ion of the AppiOV3�to any new Owner,as zequim>~d by 3 to CMR 15,287(5) C ifthe dcsiSn does not provide fat the ttsc vi garbage grmders,the restriction is understood and accepted [� Whether or not covered by a walrantY, ttr I eTstand die requirement to repair,replace, modify or take any other action as required by the:Dcpartment or the LAA.if tbv Depanwent or the LAA deteamires the System to be faili 6 tb protect public health mid safety and the environment,ns defined is 310 CMR 1 ,3 i 3 erL4)eowc aorcc to comply with a]1 terms and conditions above. Pro y nets printed name Z ro O hsr r I Daly Note: Tl i m must he sub it nlonI ith the sc tic Mtem di 1 works Permit aopGcattm M $ySteIte i:2101 n new Construction a rftogradesL, with and withnut a�arenata (stone} and withl tdnvrntional din crter'a or credited design CnteriAn Q:\Scpuic\1A i+onuwwn&e�Mificsnoa.Jee _ - �--- � ib � ��a� N ��iN � � ao � (� w.. i CERTIFIED MAIL oF'"E'�wtio ------------------ Town of Barnstable U.S.POSTAGE>>PITNEY BOWES Public Health Division BARN�A"..e.� 200 Main Street - �• =4F'� � � �'��© 9 MASS. P $plFD,AP�N• Hyannis,MA 02601 fT ZIP 026011 $ 006.560 � �. 0000336455DEC 08. 2017 7015 1730 0001 4990 3080 1 Stephen Merlesena 1 70 Main Street Suite #3 Hyannis, Suite 02601 U �l Y 4 SECTIONSENDER: COMPLETE THIS COMPLETE THIS SECTIONON DELIVERY ` j• ■ Complete items 1,2,and 3. A. Signature 1 1 ■ Print your name and address on the reverse X ❑Agent I so that we can return the card to you. ❑Addressee 1 ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. I 1.-Article-Addressed_to: -� D. Is delivery address different from item 1? ❑Yes 1 1 If YES,enter delivery as ss- elow: ❑No Stephen Merlesena j 70 Main Street Suite #3 1 Hyannis, MA 0260.1 Lt I 3. I ❑dult�Signature e Restricted D 0 Registered elivery ❑Registered Maiice Type 0 Priority Mail lRestricted.1 I ❑Certified Mail® Delivery _ 9590 9402 1933 6123 1430 17 ❑Certified Mail Restricted Delivery ❑Return Receipt for El Collect Collect on Delivery I ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationTM __nMi�[o miimhPrlTransfer_from.ServiCe label) •nsured Mail ❑Signature Confirmation 7 015 1730 0001 4990 3080 nsured Mail Restricted Delivery Restricted Delivery I over$500) I PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt L I Certified Mail: 7015 1730 0001 4990 3080 o� Town of Barnstable Regulatory Services BARNSTABtE, 0 9. Richard Scali,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 6, 2017 Stephen Merlesena 70 Main Street Suite 43 Hyannis, MA 02601 , NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 95 Goose Point. Road, Centerville, MA was inspected on December 6,.2017.by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint filed with the Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements Chipping paint and water staining was observed on the ceilings within the mud room area and within the master bedroom. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements The gable end on the left hand side of the dwelling does not have siding on it and is not weather proof or wind proof as designated by the above code. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements The floor within the V'bedroom on the left consists of painted particle board with large chips out of it. This is not water resistant or is free from defects that makes floor difficult to keep.clean and is a trip hazard. You are directed to correct the violations listed above within thirty (30) days of your receipt of this notice by repairing said ceilings and removing all sources of chronic dampness; by installing flooring in said bed room; by installing a siding on gable end of dwelling unit so that it is wind:proof and weather proof. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. However, said violations must be corrected within seven(7) days regardless of any request for a hearing Non-compliance will:result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable CC: Robert Strider; Occupant I Certified Mail:7015 1730 0001 4990 3080 Town of Barnstable Regulatory Services sn�xsr��. KAS& Richard Scali,Director s6;p. Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 December 6, 2017 Stephen Merlesena 70 Main Street Suite#3 Hyannis,MA 02601 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION The property owned by you located at 95 Goose Point Road, Centerville,, MA was inspected on December 6, 2017 by Timothy B. O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint filed with the Barnstable Health Division. The following violations of the State Sanitary Code were observed: 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements Chipping paint and water staining was observed on the ceilings within the mud room area and within the master bedroom. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements The gable end on the left hand side of the dwelling does not have siding on it and is not weather proof or wind proof as designated by the above code. 105 CMR 410.500—Owner's Responsibility to Maintain Structural Elements The floor within the.I"bedroom on the left consists of painted particle board with large chips out of it. This is not water resistant or is free from defects that makes floor difficult to keep clean and is a trip hazard. You are directed to correct the violations listed above within thirty(30) days of your receipt of this notice by repairing said ceilings and removing all sources of chronic dampness; by installing flooring in said bed room; by installing a siding on gable end of dwelling unit so that it is wind proof and weather proof. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. However, said violations must be corrected within seven(7) days regardless of any request for a hearing Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable CC: Robert Strider; Occupant Citizen Web Request Page 1 of 2 _ x s , atnss „ po 7r �+�aTfn ya9 Logged In As: Citizen Request Management Friday,December 1 2017 TOWN\ocon Welt Route to Users Search Requests Create Requests Request Information Request ID: 59209 Created: 12/1/2017 9:46:39 AM Status: Assigned To Staff Assigned To: O'Connell,Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard edit Routine work: No Estimate: No edit Date scheduled: edit Estimated 12/15/2017 Change Estimated Nov December 2017 Jan Completion Completion Date: Date: r26 Mon Tue Wed Thu Fri Sat r25 28 29 30 1 2 5 6 7 8 9 12 13 14 15 16 19 20 21 22 23 2426 27 28 29 30 31 1 2 3 4 5 6 Created By: Soto, Kathryn Priority: Medium edit Health Office Citation Numbers: edit f l Requestor Information Requestor Request Parcel Ma ;Block: O80 Lot: 000 I Tenant states property has Number p 252 — mold issues,house is leaking, there is no Flooring in one of Parcel Lookup the bedrooms,house is rotting and it is an unregistered rental. Email: Edit Requestor Information Track Request Progress Request Work History: Internal Note History: http://issgl2/InternalWRS/WRequest.aspx?ID=59209 12/1/2017 Health Master Detail Page 1 of 1 ��• .t ::) � NJYC���� � � va�. �� +�I�hh� %.K*#��'kh+'1 � t.Y^I. C+# QIY Logged In As: TOWN\oconnelt Health Master Detail Wednesday, December 6 2017 Application Center Parcel Lookup Selection Items Parcel Septic Perc Well Fuel Tank Parcel: 252-080 Location: 95 GOOSE POINT ROAD,Centerville Owner: MERLESENA, STEPHEN W Business name: Business phone: Rental property: ❑ Deed restricted: ❑ Number of bedrooms : Oj I Contaminant released: ❑ Fuel storage tank permit: ❑ Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 252-080 Developer lot:LOT 9; LOT 9A Location:95 GOOSE POINT ROAD Primary frontage:155 Secondary road: Secondary frontage: village:Centerville Fire district:C-O-MM Town sewer exists at this address:No Road index:0614 Asbuilt Septic Scan: 252080_1 Interactive map Town zone of contribution:GP (Groundwater Protection Overlay District)State zone of contribution:IN Owner Info owner: MERLESENA, STEPHEN W Co-owner:%GOOSE POINT ONE LLC Streeti:70 MAIN STREET SUITE 3 Street2: City:HYANNIS State:MA zip: 02601 country: P Deed date:1/8/2016 Deed reference:29382/182 Land Info Acres: 0.76 use: Single Fam MDL-01 zoning:RD-1 Neighborhood: 0105 Topography:Level Road:Paved Utilities:Public Water,Gas,Septic Location: Construction Info lBuilding NdYeat Buil Gross ArealLmnq Are Bedrooms lBatlirooms 1 11972 13632 11492 13 Bedroom 2 Full-0 Half Buildings value:$111,000.00 Extra features: $47,900.00 Land value: $122,200.00 Y i http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=252080 12/6/2017 TOWN OF BARNSTABLE LOCATION 9s SEWAGE#r,RObs' O 9n VILLAGE Ccn4r-ry111 C. ASSESSOR'S MAP&PARCEL ZSZI SO INSTALLER'S NAME&PHONE NO. R 4 f3 EXeayo--,i ors SEPTIC TANK CAPACITY 1600 go-1 Poo U LEACHING FACILITY: (type) 23) (size) q00 Svc NO. OF BEDROOMS 3 OWNER S c tio- PERMIT DATE: q• Z 1 - Is COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Al --27r i , 4 y T oax-Pot� 0a3 Ott Vie•-/es Town of Barnstable /�/'✓ )Departi nv t of Regulatory.Services • 1 Public Health]Division Date 200 Mai n Street,Hannis MA 02601 Date Scheduled Time R+ee Pet, 6 Suitability .Assessment for S'e � ° p ,� Performed-By. �a f'l c l C00�'a V Ci� ' Witnessed By: �� I,OC;A7CIOI�i& G NE INFORMATION, Address n ti /�_ ' Qo J Owner's Name %!e �(�Q1/✓j' fir' �tNNM//ll Address Assessor's Map/Parcel: d45a/&0 Engineer's Name U C NEW CONSTRUCTION REPAIR Telephone# Land Use:L a u, 5lopcs(96) / . Surface Stones N a6 Distance's from: Open Water Body20 l Gy ft Possible Wet Area>` fk Drinking Water Well Drainage Way >rQ y ft Property.Una ft Other ft SI TC. I:(Street name,dimensions of lot,exact locations of test holes&pore tests,locate wetlands in proximity to holes) 0 Q Q. Aa Parent material(geologic) t��rt Depth to Bedrock Wd - Depth to Groundwater. StandingWater in Hole: ' / /�_ i �' ' /V��`"� Weeping from Pit Roe — Estimated Estimated Seasonal,High Groundwater • A TERI'�TATION FOR SEASONAL HIGH WATER TABLE Method Used: G Lv Depth Observed standing in obs.hole: In. Depth to soil mottles: ItL Dcgth to weeping from side of obs.hole: in, Groundwater Adjustment fr. Index WeII# Reading Date: index Well 1pYol __ Adj.Actor,,,,,._-,_,--. Adj.Groundwater Leval , ]PERCOLATION TEST mate___�_�_. Time Observation I . Hole# Tlme at 9" Depth of Pero Time at G' Start Pro-soak Time @ — Time(9"-V) End Pre-soak / RateMln./Iach �' /L Site Suitability Assessment: Site Passed BRA Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back------- ***If percolation test is to be conducted within 100' of Wetland,you must first notify the Barnstable ConseTvation Division at least one(1) Week prior to beginning. Q_1S EPTIC\PER C FO RM.D O C .DEEROBSERVATION HOLE LOG Hole# _ Depth from Sol Horizon Soil Texture Still Color Soil. 0(her Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistan�y,96'(3ravel) 10-13 � s ayRy 2 73 • MEEP OBSERVATION HOLE`LOG Hole# Depth from Sall Horizon Sail Texture ' Soil Color" Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldcis. C013SISLrIlay.`Yo C ve g �avR4/2 c0 3z-W- G C ,�y'l� DEEP OBSERVATION]SOLE LOG Hole 9. Depthirom Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Stricture,Stones,Boulders. Co i to c Gravel) DElC+P OBSERVATION HOLE LOG -Hole 9 Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,,Stones;Boulders. Col Islutrncy, c Flood Insurance-Rate_Map: Above 500 year;flood boundary No_ Yes . . Within 500 year boundary No ` . Yes ' Within 100 year flood boundary No. Ids Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious m terial exist in all areas observed throughout the area proposed for the soil absorption systeml V eEZ___ If not,what is the depth of haturally occurring pervious material's Certification. /� //� I certify that on / (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me,consistent with . the required training,expertise and experience described in�10 CMR 15.017. Signature QAS.);l'TlC1rbRCVDRM.D0C .o CERTIFIED IVIAIL,,�. ''1 (Domestic Im �o For delivery information visit our website at www.usps.comD "L oPostage $ Certified Fee `A • � � (A O tr�dc to RetReturnPos Receipt Fee t O (Endorsement Required) �v O Restricted Delivery Fee O O (Endorsement Required) l (� O rU Total Postage&Fees EMr. & Mrs. Jeffery Richards 95 Goose Point Road Centerville, MA 02632 Certified Mail Provides: ■ A mailing receipt s ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: , ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Mails. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry: PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 1 i COMPLETE I HIS SECTION. . SENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. X ❑Agent A Print your name and address on the reverse �/ Addre ee so that we can return the card to you. B. ceived by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, C / �(a r O I 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 ' Mr. & Mrs. Jeffery Richards rv\% d1 11/14� 0a(03"1 95 Goose Point Road Centerville MA 02632 3. Service Type ' ❑Certified M4110 13 Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number j 11 !701�4 H*,12 I]0' 0 l7 01!`0 3 5�8 0 3 4 5 1 , (transfer from service/abeq Ps Form 381.1,July, 013 Domestic Return Receipt 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 i 200 Main Street I Hyannis, MA 02601 � Ii11�1'I'i'�1IIu�_III'I',i�'1i1��i1"lIf�rllarllnr,�.�l+l�rlrl.���1 Town of Barnstable Barnstable . . ; Regulatory Services Department ` , ' Public Health Division AAOs� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0345 January 19, 2015 Mr. &Mrs. Jeffery Richards 95 Goose Point Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 95 Goose Point Road, Centerville,MA was inspected on 12/10/2014 by Matthew Gilfoy, 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: • Backup of sewage into facility or system component due to overloaded or clogged SAS. You are ordered to repair or replace the septic system within sixty (60 days from the date of this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH - ean, , Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\95 Goose Point Rd Cent Ian 2015.doc x tl ®Parcel Detail F ' ;i issgl2fin �inetf�,rap�� t�;�p�rrelC�vt�jiL ;p ?III=�S?15C, THE AL d lo varcelr i Parcel Lockup' i_ is`' • Parcel Info Parcel ID 252.080 Developer lot LOTS 9&9A i f Location 95 GOOSE POINT ROADI Pri Frontage '155 I i Sec Road Sec Frontage i I Village CENTERVILLE J Fire District C-O-MM _ I i Town sewer exists atthis address No Road Index 0614 Tu Interactive Map I P • Owner Info " e . owner RICHARDS,JEFF J&S owner �J Streett 95 GOOSE POINT ROADI Street2 ��_ city CENTERVILLE State MA zip 026322 country • Land-Info Acres 0.76 _�use .Single Fam MDL-01 zoning RD-1 Nghbd 0105 � Topography'Level Road-Paved Utilities Public Water,GaS,Septic location} { i 1 Construction Info s Start }k Q�0TIC Letters 5epti,, jl Parcel Detail-Google Ch— ® / 12.13 PM Computer name : HEALTH899JF User name : flvnni Ogeratinq Svstem : Windows NT (5.1) j Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form.-Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. Cityfrown 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: 0 only the tab key to move your Matthew Gilfoy cursor-do not Name of Inspector use the return key. B&B Excavation Company Name 14 Teaberry Lane Company Address Sandwich Ma. 02644 City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of --- --Title 5(310 CMR 15.000).-The system: — ---- ---- ----- —--- - --- ------ ---- --- ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 12-10-14 Inspect 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. U t5ins.•3113 Title 5 Official Inspection Form:Sub a e ewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 95 Goose Point Rd Property Address P Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 1 Commonwealth of Massachusetts MOM Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owners Name information is required for Centerville Ma. 026321 12-10-14 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 __..._r:__❑ .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 W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is Centerville Ma. 026321 12-10-14 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is Centerville Ma. 026321 12-10-14 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be --- — - ----- - necessary to correct the failure.- - - E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area- IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, - -- - - - or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available 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. El ® 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 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 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is Centerville Ma. 026321 12-10-14 required for every page. CitylTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readin s, if available last 2 ears usage d see below 9 ( Y 9 (gp ))� Detail: 2013- 89,250gallons 2014-57,750gallons Sump pump? ❑ Yes ® No Last date of occupancy: 3 weeks prior Date Commercial/Industrial Flow Conditions: Type of Establishment: NA NA Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3/13 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 w 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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): Tank and Leach pit t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Goose Point Rd ` Property Address Jeff Richards Owner Owners Name information is required for Centerville Ma. 026321 12-10-14 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: 30+ years Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate_on.site plan):_— Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal. 41- Sludge depth: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. City/Town -� State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 32" 2„ Scum thickness Distance from top of scum to top of outlet tee or baffle NA Distance from bottom of scum to bottom of outlet tee or baffle NA How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection liquid level in septic tank was below outlet invert showing tank that the is leaking. Tank must be replaced. Grease Trap(locate on site plan): Depth below grade: NA P 9 feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: Scum thickness NA Distance from top of scum to top of outlet tee or baffle NA NA Distance from bottom of scum to bottom of outlet tee or baffle NA Date of last pumping: Date t5ins-3113 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 95 Goose Point Rd Property Address Jeff Richards Owner Owners Name information is required for Centerville Ma. 026321 12-10-14 every page. Citylrown 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: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: NA Capacity: NA gallons Design Flow: _�__. _._ NA - -- - - _ - — -_ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form m a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is Centerville Ma. 026321 12-10-14 required for 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 NA 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.): 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.): _ NA * 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 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 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.): At time of inspection leaching showing sings of backup. Pit has been stained to the top of pit. Leaching must be replaced. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth —top of liquid to inlet invert NA Depth of solids layer NA Depth of scum layer NA Dimensions of cesspool NA Materials of construction a NA T Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments Y 95 Goose Point Rd Property Address Jeff Richards Owner. Owner's Name information is required for . Centerville Ma. 026321 12-10-14 every page. Cityrrown State Zip Code. Date of.Insped-ion: D. System: information (eont.) 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 1.00.feet: Locate where public water supply:enters the building:Check one of the boxes below: ® hand-sketch in the:area below El,drawing attached separately rn O z _ ZZ 6 tsins•3113 Title 5 Official Inspection Form:Subsurface Sewage,Disposal System Page 15 of 17 AON Commonwealth of Massachusetts - Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 every page. CitylTown 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: 34'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Previous inspection report on file with BOH __ ______._,___ _❑ Checked with local excavators, installers-(attach documentation) _. ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Existing info at town office Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 95 Goose Point Rd Property Address Jeff Richards Owner Owner's Name information is required for Centerville Ma. 026321 12-10-14 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 h . t a ATLANTIC ENVIRONMENTAL P.O.BOX 2384 , , MASI4PEE,MA 02649 �a / AA Attn: Commonwealth of Massachusetts Date: 04/10/96 Town of Barnstable Board of Health 367 Main Street Hyannis MA 02601 From : Mr Michael DeDecko Po Box 2384 Mashpee MA 02649 Dear Board of Health Official, I certify that I have personnally inspected the sewage disposal system at the following address : 95 Goose Point, Centerville Ma, The information reported is true, accurate and complete as of the time of the inspection, I have not found any information which indicates that the system fails to adequately protect the public health or the Environment, If you have any questions regarding this inspection, please contact me at this number: (508)477-14-20, Thank you, Sincerely, 4chae eDecko I phone 508 477-1420 Commonwealth of Massachusetts E xecutive of E nvironmental Affairs _ ----- - aS--� ad- 0 DEFT Department of Environmental Protection SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 95 Goose Poirk Centerville Ma. Address of Owner: Michael B amber_ E xe. (if different) 8337 Venture- Waldorf, Maryland 20603 Date of Inspection: 04/08/96 Name of Inspector: Michael D eD ecko Company Name, Address and Telephone number: Atlantic Environmental P.o Box 2384 - M ashpee Ma 02649. Tel : (508) 4771420 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. The system -X-- Passes ---- Conditionally Passes ---- Needs further evaluation by the local Approving Authority. ---- Fails Inspector ' s Signature: 04 4 4t. D ate: 04/10196 The system Inspector shall submit a copy of this inspection report to the Approving Authority within thirty (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 or the Department of Environmental Protection. The original should be sent to the system owner and copy sent to the buyer, if applicable and the approving authority. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 95 G oose Point - Centerville M a. 0 wners : Michael B amber E xe. Date of Inspection: 04/08/96 INSPECTION SUMMARY: Check A, B,C, or D A) SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM 15.303. Any failure criteria not evaluated are indicated below B) SYSTEM CONDITIONALLY PASSES: ---- One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair, passes inspection. I ndicate yes, no, or not determinate (Y,N, or N D). D escribe basis of determination in all instances. If "not determinated". explain why not. ---- The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration , or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. ---- Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. The system will pass inspection if (with approval of the Board of H ealth). ----- broken pipe(s) are replaced ----- obstruction is removed ----- distribution box is levelled 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 9 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A-- CERTIFICATION (continued) Property Address : 95 Goose Point - Centerville Ma. Owner : Michael B amber E xe. Date of Inspection : 04108/96 C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: ---- Conditions exist which require further evaluation by the Board of Health in order to de- termine if the system is failing to protect the public health , safety and the environ- ment. 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 of water ---- Cesspool or privy is within 50 feet of a bordering vegetated wetland or a small marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IFAPPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNC- TIONING 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 water supply or tributary to a surface water supply. ---- The system has a septic tank and soil absorption system and is within a Zone I of a public water supply well. ---- The system has a septic tank and soil absorption system and is within 50 feet of a private water supply well. ---- The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analy- sis. for coliform. bacteria.and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate notrogen is equal to or less than 5 ppm. D) SYSTEM FAILS: --- I have determined that the system violates one or more of the following failure criteria as defined in 310 CM 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to cor- rect the failure. ---- Backup of sewage into facility or system component due to an overloaded or or clogged SAS or cesspool. 3 _SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 95 Goose Point - Centerville Ma. Owner: Michael B amber E xe. Date of Inspection : 04/08/96 D) SYSTEM FAILS (continued) --- 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 over- - - --- Ioa�ed---- -lagged SAS or cess-oe I. -- --- Liquid depth in cesspool is less than 6" below invert or available volume is less than 112 day flow. --- Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). number of times pumped --- Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. --- Any portion of cesspool or privy is within 100 feet of a surface water supply ortributary to a surface water supply. ---Any portion of a cesspool or privy is within a Zone I of a public well. --- Any portion of a cesspool or privy is within 50 feet of a private water supply well -- Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality ana- lysis. 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. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM--- PART A CERTIFICATION (continued) Property Address: 95 G oose Point - Centerville M a. Ow,►ner: Michael Bamber Exe. Date of Inspection : 04/08/96 E) LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria above : The design flow of system is 10,000 gpd or greater Large System and the system is a significant threat to public health and safety'and the environment because one or more of the following -conditions exist -- --- the system is within 400 feet of a surface drinking water supply --- the system is within 200 feet of a tributary to a surface drinking water supply --- the system is located in a 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 compli- ance with the groundwater treatment program requirements of 914 CMR 5.00 and 6.00. Please, consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 95 Goose Point - Centerville M a. 0 wner: M ichael B amber E xe. Date of Inspection: 04/08/96 Check if the following have been done : -x Pumping information was requested -of the owner--, occupant -and Boardof Health. --x None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during the 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 sep- tic tank was inspected for conditions of baffles or tees, material of construc- tion, 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 deter- mined based on existing information or approximated by non-intrusive methods ---x The facility owners and occupants if different from owner were provided with information on the proper maintenance of Subsurface Disposal System. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C _.__—_ SYSTEM INFORMATION Property Address: 95 Goose Point - Centerville M a. Owner: Michael B amber E xe. Date of Inspection: 04108/96 RESIDENTIAL: Design flow : --7-3o gallons Number of bedrooms : 03 Number of current residents:cn Garbage grinder (yes or no) : of> - - Laundry connected to system (yes or no): LA&'S --�-Seasonal use use (yes or no): NO Water meter readings,if available: ti(A- Last date of occupancy : tj'n\- , COMMERCIALANDUSTRIAL : Type of establishment: Design flow : gallons/day Grease trap present: (yes or no) Industrial waste holding tank present (yes or no) : Non-sanitary taste discharged to the Title 5 system (yes or no) : Water meter readings, if available : Last date of occupancy: Other: (Describe) ............................................................................................................ Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information : aL..b �... �. t d....Qwljr1 Sys tern pumped as part of inspection (yes or na. .......N 0........ if yes, volume pomped: .................... gallons Reasonfor pumping:............................................................................................................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 95 Goose Point - Centerville Ma. Owner: Michael B amber E xe. Date of inspection: 04108/96 TYPE OF SYSTEM 4 Septic tank/distribution boxlsoil absorption system --- Single cesspool - O verf low cesspool --- Privy --- Shared system (yes or no) (if yes, attach previous inspection records, if any) --- Other (explain)........................................................................................... APPROXIMATE AGE of all components, date installed (if known) and source of information ................ ................................................................................................................................................ ................................ Sewage odors detected when,arriving at the site : (.yes or no)......�G.. SEPTIC TANK : ... (locate on site plan) Depth below grade: .. ...... Material of construction: ...?. concrete ......... metal ........ FRP ........ other (explain) ................................................................................................................................................ Dimensions: Sludge depth :....�:(...... Distance from tap of sludge to bottom of outlet tee or baffle:.....3...................... Scum thickness :.....y.............. 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 :..I2................... Comments : (recommendation for pumping , condition of inlet and outlet tees or baffles, depth of liquid level in relation to a tlet invert, str ctur I integrity, evidence of leakage, etc.)...................... 's...L n�tT ..-.Av- jc..�, ...(j.�4..`.�2.U�,�. ur.'...�4Z..�.!?Tl,� .. uc�T... .. rt ► Tow•—�- .✓.?:!i1..!.N t-crt�? .... 'a.�a�Y�..1�9....4.✓..� R�cuc�..4. ..(�alcc�q� . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 95 Goose Point - Centerville M a. Owner: Michael B amber E xe. Date of inspection: 04/08/96 GREASE TRAP : ...... (locate on site plan) Depth below grade: ............... Material of construction: ........concrete.........metal........FR P........other(explain).... .......................................................................................................................................... Dimensions:.............:...:.::.- . Scum thickness:........................ Distance from top of scum to top of outlet tee or baffle:....................................... Distance from bottom scum to bottom of outlet tee or baffle:............................... 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.)........................ ................................................................................................................................................ ................................................................................................................................................ TIGHT OR HOLDING TANKS:.W)..... (locate on site plan) Depth below grade:............... Material of construction:........concrete........metal.........FR P..........other (explain).......... ................................................................................................................................................ D imensions:............................ Capacity:....................gallons Design flow:...............gallons/dkv Alarm level:............................. Comments: (condition of inlet tee, condition of alarm and float switches, etc.) ................................................................................................................................................ q SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PAR T C SYSTEM INFORMATION (continued) Property Address: 95 Goose Point - Centerville M a. Owner: Michael B amber E xe. Date of inspection: 04/08/96 DISTRIBUTION BOX:.A. (locate on site plan) Depth of liquid level above outlet invert:................... Comment: (note if level and distribution equal evidence of solids carryover, evidence of leakage into orout of box, etc.).................................................................................................................. ................................................................................................................................................ PUMP CHAMBER....Qv... (locate on the site) Pumps in working order: (yes or no)............... Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.).................... ................................................................................................................................................ .............................................................................................................. ................................. SOIL ABSORPTION SYSTEM (SAS):....�e, ....... (locate on site plan, if possible; excavation not required, but may be approximated by non- intrusive methods) if not determined to be present, explain: ................................................................................................................................................ ............................................. Type: leaching pits, number: leaching chambers, number:........ leaching galleries, number:........... leaching trenches,number , length:..................... leaching fields, number, dimensions:................... overflow cesspool.,number:.......... Comments: Ioke condition of soil , signs of h draulic failure, level of pondin , c ndikion of v ekak on, . ........................ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property address: 95 Goose Point - Centerville Ma. Owner: Michael B amber E xe. Date of inspection: 04/08196 CESSPOOLS:...UO.... (locate on site plan) Number and configuration: .................................... D epth-tap of liquid to inlet invert: ........................... ---- - Depth of solids layer: —- — -- - --- - ............ . Depth of scum layer: ............................................... Dimensions of cesspool: ...................... Materials of construction: ..................... Indicator of ground water: .................... inflow (cesspool must be pumped as part of inspection) ................................................................................................. ................................................................................................. Comments: (note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation, etc.) ................................................................................................................................................ N� PRIVY : ...... (locate on the site) Material of construction: ................................... Dimensions: ...................... Depth of solids: ................ Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) ................................................................................................................................................ ,aiA SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address : 95 Goose Point - Centerville Ma. Owner: Michael B amber E xe. Date of inspection: 04108/96 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate at wells within 0 ...._ 6 (0o Q3 (Is DEPTH TO GROUNDWATER: i Depth to groundwater: '�?.4....feet Method of determination or approximative: ............................... .. . ..... ... . . . . . . . . . .. ... ..... .. .... ... H .. ..... ..... ..... I A .... Existing Deck 77 . ..... ..... ..... ... . ..... ..... ..... .... 18-0 X X .......... .. ........... ...... 3'-0" ----------------t- U existing dining room O Bedroom I 4' L 0 0 existing kitchen 9 convert existing garage to 9 handicap accesable bedroom and bath . 214 2'..&" T�- 2'-&" X all Framing to remain -s unheated mudroom existing llvlmgroom Bedroom 2 remove existing garage door n existin la out and install amdersen tw 2-24310 x 4'-016" L= 2-4' I per -onsiruction Centervills, MA 546A Higgins Crowell Rd PHONE:508-778-0111 T541 upper Ur West Yarmo:uth, FAX:508-778-5010 MA admin@tupperco.com DRAWN BY:Rick PAGE #:5 02673 SCALE: NA DATE: January 08, 2016 3-0 Blockin rat 8' Q Q in in typical floor system- �,-2 „ 2x1O joists at 12"O.C.3/4 O.S.B. over _ t�g C g Q convert existing garage to handicap accesable bedroom and bath cv R v x all framing to remain Existing sheatrock and insulation to remain a remove existin garage door g g g I! and install andersen tw 2-24310 x d'-OZ'e° Floor Framin g 135 Goose Point Rd, Tupper Construction Centerville, MA 546A Higgins Crowell Rd PHONE:508-778-0111 West Yarmouth, FAX:508-778-5010 MA admin@tupperco.com DRAWN BY:Rick PAGE #:2 02673 SCALE: 1/4"= 1' DATE: January 08, 2016 ALL SYSTEM COMPONENTS SHALL BE NOTES MARKED WITH MAGNETIC TAPE OR PROVIDE MIN. 20" DIAM. WATERTIGHT SYSTEM PROFILE COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM 1S ASSUMED ACCESS COVERS TO WITHIN 6" OF FIN. GRADE r� \ ACCESS COVER AT FIN. GRADE (Nor To SCALE) PROVIDE INSPECTION PORTS TO 2. MUNICIPAL WATER IS EXISTING �oG�o Q TOP FOUND. EL. 61.3 WITHIN 3" OF FINISH GRADE 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 59.5' MINIMUM .75' OF COVER OVER PRECAST 2% SLOPE REQUIRED OVER SYSTEM 59.0'-59.6' MINIMUM 1' OF COVER MINIMUM .75' OF COVER NOTE: 2 MIN. WALL 4. DESIGN LOADING FOR ALL PROPOSED PRECAST '" v OVER POLY TANK OVER PRECAST THICKNESS REQUIRED UNITS TO BE AASHO H-12 n ta.. 4"OSCH40 PVC 16.1"(1.34') PIPES LEVEL 1ST 2' 5. PIPE JOINTS TO BE MADE WATERTIGHT. M *57.1'f* 56.82' PRO56.57' { 56.63' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE Locu GALLO WITH 310 CMR 15.000 (TITLE 5.) a SGAS0000 ° BAFFLE °moo 00 000 56.23' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND ° NOT TO BE USED FOR LOT LINE STAKING OR ANY Q o ' 0.92' OTHER PURPOSE. 56.44 �/ 56.27 00 0000 0 / 0 0o y 55.31 Wequ 8t rc a o CRUSHED STONE OR MECHANICAL a$ H-20 HI)H CAPACITY UNITS 8.' PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. ( 2 % SLOPE) (COMPACTION. 15.221 [2]) (WATER TEST D'BOX NO STONt' PROPOSED Tv(jl� DEPTH OF FLOW = 4' FOR LEVELNESS ) 9. COMPONENTS NOT TO BE BACKFILLED OR ° ° CONCEALED WITHOUT INSPECTION BY BOARD OF 3 REQUIRED TEE SIZES: LINE OF HEAL AND PERMISSION OBTAINED FROM BOARD 0 INLET DEPTH = 10" MIN. BELOW FLOW OF HEALTH. OUTLET DEPTH = 14" MIN. BELOW THE FLOW LINE ( 1 % SLOPE) 6.81' - 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP ( 1 % SLOPE) CALLING DIGSAFE (1-888-344-7233) AND FOUNDATION- 14' SEPTIC TANK 13' D' BOX 6' LEACHIN' VERIFYING THE LOCATION OF ALL UNDERGROUND & NOT TO SCALE FACILITY OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF WORK. *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL BOTTOM TH1 EL. 48.5' ASSESSORS MAP 252 PARCEL 80 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS 11. ANY UNSUITABLE MATERIAL ENCOUNTERED PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM SHALL BE REMOVED 5' BENEATH AND AROUND THE NOTE: A NOTIFICATION OF I/A REQUIRED PROPOSED LEACHING FACILITY. 12. EXISTING LEACHING FACILITY SHALL BE PUMPED AND REMOVED OR PUMPED AND FILLED WITH CLEAN LEGEND.- SAND. SYSTEM DESIGN: 99 - ExIsrlNc CONTOUR C GARBAGE DISPOSER IS NOT ALLOWED X 99.1 EXIST. SPOT ELEV. 196�1 LOT AREA 99 PROPOSED CONTOUR 32,770 Sq. Ft. \5 7.79 O DESIGN FLOW: 3 BEDROOMS © 110 GPD = 330 GPD \\ USE A 330 GPD DESIGN FLOW 198.41 PROPOSED SPOT EL. TH1 \ SEPTIC TANK: 330 GPD (2) = 660 TEST HOLE USE A 1500 GAL. H-10 POLY SEPTIC TANK 2% SLOPE OF GROUND X58.25 \ \X 57.61 LEACHING: UTILITY POLE � �s57.15\3�1 \ 4.73 °SF/LF x 6.25, LENGTH = 29.56 SF PER HIGH 60 32 \ CAPACITY INFILTRATOR UNIT FIRE HYDRANT \ __ O MAY APPEAR IN DRAWING 58.38 ` 330 GPD/0.74 GPD/SF = 4459 SF LEACHING IREQ'L7 NOTE: NOT ALL srMeoLs 5 .08 Q X 55.29 / \ MINIMUM 400 SF BOTTOM AREA REQUIRED PER DEP 8.'19� �807 9 69 7 . \ APPROVAL I X � Ilk � \ TEST HOLE LOGS off'% \ 400 SF 17.69 SF UNIT = 22.6 UNITS BOTTOM ARE ONLY 1.29 6'"0A"- Gym0 \ DANIEL E. GONSALVES, SE #13587 -moo / c 60.44 \ THEREFORE, USE GRAVELLESS SYSTEM OF (23) H-20 HIGH ENGINEER: 2Q y� �J/ DONNA MIORANDI, IRS s < c c� \ C PACITY UNITS IN FIELD CONFIGURATION SHOWN WITNESS: y�o X 7 1 / C- <�� ��c� \5\ 49 23 NITS x 17.69 SF = 406 SF > 400 SF (BOTTOM ARE DATE: 1/22/15 53 57 �� \ 9.8� 0.62 \ 3 53.02 CD .�3 �� �� 60. 8 6085 .62 PERC. RATE _ < 2 MIN/INCH 1� �'O 5 b 79 \ 23 UNITS x 29.56 SF/UNIT = 680 SF (EFFECTIVE) CLASS I SOILS P# 14623 _ O 9.80 QP�oo 680 SF (0.74) 503 GPD (OK) ELEV. ELEV. O" 59.5' O" 59.5' X 9 � 61.13 ELEC. METER 0 SLAB (UNDERGROUND LINE) MA FILL FILL 01 60.77 APPROVED DATE BOARD OF HEALTH 04 10" 6" �� 0 TITLE 5 SITE PLAN A A X 53 57 0� 0.35 OF LS LS 60 60.24 10YR 4/2 58 4' 10YR 4/2 58 8' J �� 95 GOOSE POINT ROAD 13 $ CENTERVILLE, MA U, B B 59.16 ; 4 58 9 PREPARED FOR - ; LS LS B&B EXCAVATION/MERLESENA 34„ 10YR 5/6 56.6' 32" 10YR 5/6 56.8' 'bi 1 DATE: FEBRUARY 20, 2015 6 BENCH MARK - TOP OF WOOD X 155.89 Co STEP AT DOOR. ELEV. = 61.0' REV: APRIL 16, 2015 (SAS SIZE) 1 PERC C ��H C 58.89 OF MA3s ZH OF Mgss�c M/CS M/CS NOTE: DASHED LINES INDICATE 446 SF o��`� off 508-362-4541 CONVENTIONAL SIZE LEACHING AREA DANIEL 9cy� o DAANiEL ti�� fax 508-362-9880 A. o , 2.5Y 7/3 2.5Y 7/3 o OJALA 0 OJALA downcape.com v CIVIL m �oo.40980s�oP down cape eagIaeering, Inc. 132" 48.5' 132" 48.5' °��Fcr TE¢ `` `gNFSSR\E f,� civil engineers ENCOUNTERED Scale: 1"= 20' � '`�� ss�0LN� �` land surveyors NO GROUNDWATER '� i 939 Main Street ( Rte 6A) �( DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 DCE tt 15-003 0 0 20 30 40 50 FEET 15-003 B&B-MERLESENA.DWG i I