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HomeMy WebLinkAbout0104 GOOSE POINT ROAD - Health 104 Goose Point Road A= 252-046 Centerville j i r OO S M E A D No. 2-153LOR UPC 12534 smead.com • Made in USA �4CYC(FO �J C0- z "b p As FIM USED IN TIMS PRODUCT LINE i 5 I REQUIREaAENTS Of THE SR PROGRAMWWWWWOOPAMM CERTIFlED SOURCING j .i/ v e Commonwealth of Massachusetts Title 5 Official Inspection Form a5,07- oq160 o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable (' �.C- MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information 1. Inspector: Michael DeCosta,Jr. Name of Inspector Wind River Environmental Company Name 46 Lizotte Drive Suite 1000 Company Address Marlborough MA 01752 City/Town State Zip Code (508)400-8083 SI 13230 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: Passes ❑ Conditionally Passes ❑ Needs Further Evaluation by the Local Approving Authority ❑ Fails v January 12,2021 Inspectors 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 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. 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. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is Owners Name required for every page. Barnstable MA 02632 January 12,2021 City/Town 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: Q 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: All the covers are on risers to 6"below grade. 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 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.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 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 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 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): 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 failing to protect public health, 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: t5ins.doc 0 rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments " 104 Goose Point Road Property Address Owner Mikhail Starikov information is Owners Name required for every page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) ❑ 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 ❑ Q Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Q Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5ins.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 ' 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection C. Inspection summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ Q Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Q Liquid depth in cesspool is less than 6"below invert or available volume is less than'/z day flow ❑ Q Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped:_ ❑ z Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ z Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Q 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.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000gpd-10,000gpd. ❑ Q 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 t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 5 of 18 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 CityfTown State Zip Code Date of Inspection C. Inspection summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat,or answered"yes"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 Q ❑ Pumping information was provided by the owner,occupant, or Board of Health ❑ Q Were any of the system components pumped out in the previous two weeks? Q ❑ Has the system received normal flows in the previous two week period? ❑ Q Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) Q ❑ Was the facility or dwelling inspected for signs of sewage back up? Q ❑ Was the site inspected for signs of break out? Q ❑ Were all system components,excluding the SAS, located on site? Q ❑ 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? Q ❑ 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: Q ❑ Existing information. For example,a plan at the Board of Health. ❑ Q 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)] t5ins.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 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 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 GPD Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes R1 No Does residence have a water treatment unit? ❑ Yes Q No If yes,discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes Q No Seasonaluse? Q Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): 345 GPD Detail: Usage: 33,700 CF x 7.48=252,076 gallons/730 days=345 GPD. Reviewed water bills provided by homeowner. Sump pump? ❑ Yes Q No Last date of occupancy: 2020 Date t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System 0 Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12, 2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes,discharges to Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): General Information 3• Pumping Records: Source of information: Wind River Environmental Was system pumped as part of the inspection? Q Yes ❑ No If yes,volume pumped: 1000 gallons How was quantity pumped determined? Quantity measured by pump truck Reason for pumping: Check structural integrity of the tank t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Work Order# 0217082199 Cust# 1147205 Customer Since: 2 0 0 2 Tax: 6.2500 % Job Comments Tech Comments 01/12/2021 SVC 1000 Galls for T5 inspection CC & Signed Cover(s) secured. Re called in dig safe ticket # 2021-010- consent on file -RC 2631 clear 1/8/21 after llam. Recommended No Recommendation. System not Operating Fine. Low water level. Light top solids. Moderate bottom sludge. Both baffles are intact. Main line Not Applicable . No filter is present on the tank; current tank can be outfitted with a filter. Cover(s) secured. Repairs needed: Both tank and dbox are below operating levels, either system is leaking or house is _vacant either way t5 can not be completed until confirmation, homeowners need to run water for week and we will come back to reinspect. Title 5 Inspection as of now a conditional pass, both tank and dbox are below operating level, either system is leaking and tank seal needed or homeowners not living in home, homeowners must run water for 7-10 i-n PnSnrP annnnh water is nninm intn ftNsi-Pm —ri wP ran System Owner System Location Mikhail Starikov Primary Home 104 Goose Point Road 104 Goose Point Road Centerville, MA 02632 Centerville, MA 02632 (617) 697-1588 Starikov Mikhail : (617) 697-1588 Service Date: TVE 01/12/2021 11:45 AM Frequency: Call to Confirm: Service Type: Standard Previous Service: 01/05/2021 Approx. Gals: 1000 CCLS: Location Details: Depth Below Grade: Custom Clean: Cust Home: NO Filter: Township: Inspection/T5: County: Barnstable Build Up: !Description s _ Qty Unit Price Ext Price Pumping 1000 1.00 $ 275.0000 $ 275.00 Environmental Compliance - Residential 1.00 $ 3.0000 $ 3.00 Fuel / Energy Recovery 1.00 $ 20.6250'$ 20.63 Subtotal: $ 298.63 We suggest these 3 keys steps to keep your system healthy: Tax $ 0.00 • Regular servicing • Use CCLS bacteria additive Total $ 298.63 . Use a filter Disposal Site: Plymouth Disposal Volume: Payment Detail: Waste Code : Pumpseptic 1000.0000 Visa xxxxxxxxxx8656 06/2022 Sales Rep : NE_Repairs Installs CSR: Ryan Council Due on Receipt Truck : Technician : Joshua Bell On Site : 11:44 AM FPO Number: Tech Notes : System Operating Fine. Normal water level. Light top solids. Light bottom sludge. Inlet baffles are intact. Main line Clear. No filter is present on the tank; current tank can be outfitted with a filter. Cover(s) secured. Recommended Boost additive,CCLS additive. X Customer Signature WINDRfVER ENVIRONMENTAL Remit payment to 46 Lizotte Dr Suite 1000,Marlborough,MA 01752 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments yt 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: 0 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/Altemative 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: 2013 per plans Were sewage odors detected when arriving at the site? ❑ Yes 0 No 5- Building Sewer(locate on site plan): Depth below grade: 4 feet Material of construction: ❑ cast iron 0 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.): Unable to enter the house and check piping due to COVID-19. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 9 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3.6 feet Material of construction: Q 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: 8'x 5'x 4' Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle 36" Scum thickness 4" 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 15" How were dimensions determined? Tape Measure 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 inlet and outlet covers are both on risers to 4"below grade.The tees are in good condition.There is no filter installed on the outlet.The liquid level is normal with moderate solids and sludge.The tank appears to be structurally sound and not leaking. Recommend pumping the tank and cleaning the filter annually. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is Owners Name required for every page. Barnstable MA 02632 January 12,2021 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): 8. 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 t5ins.doc rev.7/26/2018 Title 5 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 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) 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 9. 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.): The distribution box cover is on a riser to 8"below grade.The liquid level is normal.There is equal flow to the outlets and minimal carryover into the box.The box is in good structural condition, is watertight and not leaking. t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments z" 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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.): * 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: Type: ❑ leaching pits number: z leaching chambers number: 36 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number,dimensions: ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5rOfficial Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s' 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS)(Cont.) Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): Dry, sandy,soil with no ponding and no signs of hydraulic failure.The vegetation is normal. 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.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12, 2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 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: Q hand-sketch in the area below ❑ drawing attached separately ' z . 3 I 0 p )3 Apo + 9. 41 .r '• , t5ins.doc rev.7/26/2018 Tille 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 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12, 2021 City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: 0 Check Slope 0 Surface water 0 Check cellar Q Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: Q Obtained from system design plans on record If checked,date of design plan reviewed: 2013 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: Groundwater information obtained from the soil logs on the design plans. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 I Commonwealth of Massachusetts Title .5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 104 Goose Point Road Property Address Owner Mikhail Starikov information is required for every Owner's Name page. Barnstable MA 02632 January 12,2021 City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q A. Inspection information:Complete all fields in this section. Q B. Certification: Signed&Dated and 1,2,3, or 4 checked Q C. Inspection Summary: 1,2, 3,or 5 completed as appropriate 4 (Failure Criteria)and 6(Checklist)completed Q D. System Information: For 8:Tight/Holding Tank- Pumping contract attached For 15: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 16: Explanation of estimated depth to high groundwater included t5ins.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 r + No. G Fee 166 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Tipplitatlon for Disposal *pstem ConstCUttlon 3p¢rmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot N . f-, I Owner's Name,Address,and Tel.No. e 0- Assessor's Map/Parcel --0 Instal er' ame ddress an Tel. Gv 1/csm esi ner's Name Address,and Tel. o. �2�s� �a�� le . Oa6 age®,C� / �V Ulr�� � Type of Building: Dwelling No.of Bedrooms3. Lot Size , sq.ft. Garbage Grinder( ) Other Type of Building ,�.L� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. , 4034/-K _ Y (2�_6 Description of Soil Nature of Repairs or Alterations(Answer when applicable) �CQ Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Signed Date Application Approved by Date t Application Disapproved by Date for the following reasons Permit No. t� f Date Issued to a'k V. No. w Fee led THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:_ PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes , Zippliration for Disposal *pstrm Construction j3erinit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components I! Location Address or LotNo./rj� �e, f yl Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer:flame,Address,and Tel Nod.(ZUjZ11fir rq esigner's Name Address,and Tel.No. ^911 P)� g?�i G6� 0 �7` l�`y�e i410, o 6 ( . -Fex 9� E c�w t, tM Ck C) Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Flo Jr No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd ` Plan Date Number of sheets Revision Date Title / Ili Size of Septic Tank Type of S.A.S. Description of Soil�+ s Nature of Repairs or Alterations(Answer when applicable) i i Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in., accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed � Date '— j Application Approved by Date / � { Application Disapproved by Date -for.the following reasons r� � Permit No. r ao -3 o Date Issued ------------------------------------------------ ------- - - ---------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifirate of Compliance THIS IS TO CERTIFY,that the On-site Se age Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by at '� has been constructed in accordance with the provisions of`F't 5 and t Disposal System Construction Permit No,�/3"�'0t dated Installer Designer p #bedrooms - Approved design flow '31 n gpd The issuance of this permit shall not be construed as a guarantee that the system will function , as designed. Date CC� Inspector l - -- _ --- - - -- - --------------------------------------------- No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal &pstern Construction permit - Permission is hereby granted to Construct ) Repair( Upgrade( ) �and ( ) c System located at Iol? i� 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 o 1 ed within three years of the date of this permit. Date / / �� �� Approved by Town of Barnstable Op'THE Regulatory Services Thomas F. Geiler, Director • HA"ffrnBLL 9�p1, Public Health Division Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-362-4644, Fax: 1408-790-6304 Installer & Designer Certification Form �f6 i3 ZS // Date: Sewage Permit#-20/? 23 Assessor's ivlap\Parcel � So Designer: '-` 2l` � �. . b —T_� Installer: Address: T y ��G :address: �!. VIAc ZkI1 was issued a permit to install a (date) (installer) septic system at �� C�a / �)►til lam+? based on a design drawn by (address) `� e� �S L dated D� ®� ' 3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation o`thI distribution box andior septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any: vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. OF MgSs9� D M R N M. yG A(1nst&aller'_s/Sivnature) o: 40 S1£G/STE�P� �l NITAR (Designer's Signatttre) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Health/Septic/Designer Certification Form 3-26-041doc tj TOWN OF BARNSTABLE A, LOCATION/ O.�'//z SEWAGE# �0�� VILLAGE ASSYSSOOR'S MAP / ARCEL� " Oy INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY:(type) NO.OF BEDROOMS .' OWNER �.n�tr '`� PERMIT DATE:,z 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 leachin faci'ty Feet FURNISHED B' / 4C \\ drv�oj . .vsLl 1 A 5 3 I Town of Bairnstable. P# ofTME�, Department of RekWatory Services Public Health Division Bate_ �AENB'rABLE, I . ,'6¢ tee$ 200 Main Street Hyannis MA 02601 �lfDtM�h i• J Date Scheduled L Time Fee Pd. i Soil Suitability AssessM"ent for ,dew e Disposal Performed By: Witnessed By: i LOCATION & GENE_ RAL INFORMATION Location Address P-0_ Owner's Name Address Assessor's Map/P4rcel: ��� I Engineer's Name 1J ` . �.✓� � Qs[ NEW CONSIRU L� i ION REPAIR TelephoneS)A (c'ri J Land Use 12R)W WE*ft KLI Slopes(40) s" Surface Stones NrnC� Distances from: Open Water Body 7 Z b0 ft Possible Wee Area �>2­0(,)ft Drinking Water Well ft hrainage Way ft Property Line v ft Other ft SKETCH:($treet name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) i i Parent material(geologic) Depth to Bedrock Depth to Groundwater. Standing Water in Hole:' 4 i Weeping from Pit Face Estimated Seasonal14igh Groundwater �� 1 DtTE ATION FOR SEASONAL HIGH WATER T"L,E Method Used: i. _in. De th 10 Sall m9ttles: In. Depth Qbperved standing in obs.hole: p fr- Depth toiweeping from side of obs.hole: In. Oroundwnter AdJuntment Index Well# _ Reading Date: Index Well levy.) ! Adj,f etor,�,._,r� AdJ•Ornundwnteri.evel,,,a i PERCOLATION TEST . Drite.�. ._. 'ln�e_ Observation I Time at 9" Hole# i ��rI�SCJ,t Time at 6" Depth of Pere D I I Time(V-6") Start Pre-soak Time.@ End Pre-soak L-Z L; Rate Min:/nch Site Suitability Assessment: Site Passed�_ Site Failed: Additional Testing Needed(YIN) Original:.Public x-e;ilth Division Observatiot Hole Data To Be Completed on Back— ***If percolafiion testis to be condracted within 100' of wetland,you must first notify the Barnstable C41iservation Division at least one (1) week•prioir to beginning. DEEP OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel It tt �q [d4M S N q C� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil-Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel) b Got Mee - ow SAUAZ, S` goq, I (,2' 07 m, od 7- DEEP OBSERVATION HOLE LOG Hole# N d Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent Rb Gravel DEEP OBSERVATION HOLE LOG Hole# n/ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consisten ra I Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervi ys�rlaterial exist.in all areas observed throughout the area proposed for the soil absorption system? ('' If not,what is the depth of naturally occurring pervious material? Certification I certifythat ondate I have passed the soil evaluator examination approved by the (date) Department- E4nv !7-- Signaturental Protection and that the above analysis was performed by-me consistent with the required tra ni g,experti/e�and experience described in 3.10 CMR 15.017. G. " 1 Date O:\.SEPTIC�PERCFORM.DOC r. - AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION SEWAGE# VILLAGE ;��I�.� ASSESSOR'S MAP ARCS _ O INSTALLER'S NAME&PHONE NO. � mil' � - SEPTIC TANK CAPACITY ; � r;ado LEACHING FACII.YTY:(type) NO.OF BEDROOMS ' OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom.of Leaching Facility Private Water Supply Well and LeachingFacility f Feet tY(I arty wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility wetlands exist within Feet � 'hh'�f any 300 feet of leachin fac''ty �. l/ Feet FURNISHED BY � JL i http://issgl2/intranet/propdata/prebuilt.aspx?mappar=252046&seq=3 6/3/2013 �• l No.... 1 Fms.....T�.47`�`2 THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH vi 1 -0.. ...�.............OF.......... �� ..... .......... .._... v Appliration for Disposal Works Tons#.rwiurt rani# Application is hereby made for a Permit to Construct (t! ) or Repair ( ) an Individual Sewage Disposal System at: ................-T /3 A....C��:t >q..T.-... �!_ .._... ...CAN TL��v-�LL. .. ...................... ................ Loca ion-Address or It No ............................................... u r[.a. .............. Own r Address a R .�.'�.:.... �l s.S 1,1.7 ___ _ • --- -----•.. ................... ............................•----•----•------........................................ Installer Address ••• Type of Building Size .......Sq. feet U Dwelling No. of Bedrooms.. 0 0 3�_ .......Ex anion Attic a ng— -....-._-- .- p ( ) Garbage Grinder ( ) Ga4 Other—Type of Building .........:.................. No.. of persons............................ Showers ( ) — Cafeteria ( ) QOther fixtures ...................•----...-•--•----� --•••-••••.........................--------............_..................-•••-•--•....................... WW Design Flow...........PA........................gallons per�ers6rfper day. Total daily flow..........-.3,0..................... WSeptic Tank—Liquid capacity./LTZ.Zkallons Length.-EC....... Width:A, �............. Depth..ter`.. .. x Disposal Trench—=No.......... ......... Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No.......j............ Diameter...... ....... Depth below inlet......&_.......... Total leaching area..�?610..sq. ft. Z Other Distribution box (t4�' Dosing tank ( )`•" Percolation Test Results Performed by..... ................................... Date......J31&J. Test Pit No. 1_.L ....minutes per inch Depth of Test Pit...l. .......... Depth to ground water........................ 44 Test Pit No. 2................minutes per inch Depth of Test Pit...._........._..... Depth to ground water........................ a ..................•-----. ...................-•-••--••••-•••---•...............-•••--•....................................---.......................__----. O Description of Soil..... ..-". .�. T ►?—.{_..`3. ��.-Cad'_'... L 'AN....p'`1C-alt ...�-�l4hl.lr ..... ....COAR-4if�;:1....._a �t l-... 7 2,t_ 1.. ¢.....ci ' -�.�.-.................................................................... U Nature of Repairs or Al ins—Answer when a icabl J. :N..J.N.r�a....�5� .C�.l. ............ Agreement: 1 NST Ti ON A-IL/D <—oE7-e ,(--,/ ,N 0-'2 l TT t� 7�_ PS;—`77�- k 5 &)Si; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of LITLZ 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 boarV of health. uKz° e Date Application Approved By........... :. .......... ...................... ..... .�./ . ............ Date Application Disapproved for the following reasons:............................................................................................................ ..............................................................................••-------...............---...........-............--•--..-------............-•-•---• ....... �� , 0 ......Date .... PermitNo............. ...----. ......--- --...... Issued...._..-•-----.................. ...... Date Ficz THE COMMONWEALTH OF MASSACHUSETTS —�-- BOARD OF HEALTH .............OF.......... f=111U S- rtA_1SL .................. Appliration for Disposal Works Tonutrurtiun 11rruat Application is hereby made for a Permit to Construct (t/ ) or Repair ( ) an Individual Sewage Disposal System at: Location Address or Lot No• .................................... - •�-•�•- ..........(y-►?mot (`�E?;/1 i'/;��...................................................../ ?�i, f� l ;A Ajg Owner! Address ....»......_. a :'_... .................... .... .... ddrea............... ---•--••• "A e. .•... .5................................. Installer dd Type of Building- ------ Size Lot_..ZQ '�.�..... Sq. feet ._ Dwelling—No. of Bedrooms... J_�..:�_^..Expansion Attic ( ) Garbage Grinder ( ) 914 Other—Type of Buildin .............................^No. of persons............................ Showers ( )�= Cafeteria ( ) QOther fixtures . ••---••----------------•--•• ........ Design Flow........._.,I/fi..................... llons r_e on a da Total dail flow..........- �O W � - -••ga per P P y' Y ,� _�•_ .....................gallons. WSeptic Tank—Liquid capacity.1/_:-...gallons Length.�+�........ Width:-...�.... Diameter................ Depth..�`�_4.... x Disposal Trench—No....................: Width.................... Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No........ Diameter......1'2..._..... Depth below inlet.....?-._._______ Total leaching area... !10..sq. ft. Z Other Distribution box (tf) Dosing tank ( ) Percolation Test Results Performed b FA!R A n11�S ....... ... Date......16.1 P?•�� .........:.... a y..... ....... .. Test Pit No. 1.. .____minutds per inch Depth of Test Pit...A ........ Depth to ground water....................... r=. Test Pit No. 2................�minutes per inch Depth of Test Pit..............._.... Depth to.ground water........................ O Description of Soil. ...... [ " TZ,"' -ScSi s.n�L / 3 � ""(A a",e_zt=Rhl MP,,)•U ..... _... .. ......................................................... ,._ 114 C1—FAN ��? i�S� l�ttt -D)o `i" V ....................................... ....... .................... W ......---�1 Nam_ ............... . U Nature of Repairs or Alterations Answer when applicable t r� !-n1 !:,. ��A 1 ? _ N - ..t1!.......... ...... .� ...... �T7'r _..:pp�J ........lib tc,�I�Tt .. �.. ..... Agreement: 1 t�1�-l-f?z s-A 7 £�N �0 C'C-�G'r y I N VQ/Z t 7 i',n)�.....�; The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with I/V FP IC r the provisions of"ITL: 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. �"rz"`e �Y Signed.. 1...;x:�. ..... ,I ;.............. �...... . .................. - -. "' r Date Application Approved BY ....... .............................. ..................... ... �2-...................... Date Application Disapproved for the following reasons:_..........:........................................................................--••-- ..._.. .........---•...........................••-•-•-------..._._.........-•--•----.._....---........._.........._.:.... ........_._........................... ._.._......_.._........................... Date Permit No................ � ...... Issued.. Date ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..................... ................OF....................................................................... Tnxtif iratr of Tomplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by...................................................:.. a..........!.Aw. .. ....... t ► a. .-•-••-..... .._.................................................___.... Installer ................................ -___.,..,_....... . ... ---.............. .. ... has been installed in accordance with the provisions of TITI 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... ....Z-^_.-... 9.....1-....... dated.... .. �.I.- ..6n.............. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.............................? ....�: ......_.............--.............. Inspector...... `....? ....._....._....._........ .................. THE COMMONWEALTH OF MASSACHUSETTS ��1'�IV�N�j t�TJEauv��'2 BOARD OF HEALTH �"' ±�k 21,v U �.s T A t OF.......................... oa No......................r� I Fzz.......:. ' Disposal Imorka Tonutrurtion trrutit Permission is hereby granted...................�..:� f ( A uQ . V t , -, (=ti w C-4 .......---•---•-•--.................• -- -.....................................-----....................... to Construct ( ) or Repair (—) an Individual Sewage Disposal System at No.......... t•_ [ =��A t-�c���- �-. . 26 e___ � - ..... ..................................................................._.. --_- - .........-•---....... Street Z�<^ -1 .15-1 i as shown on the application for Disposal Works Construction Permit No..................... Dated.. .��...).:. ...1�?t'^„ .........................::..........................:.................................................» DATE....:.... ! [ (.l' � Board of Health . ........_.....................---....._•--....................._ ��&•.a�Y;; 1;�,, 4, a.•.'.. ay ..� Mb� 1 � ,>•. ' r ''w 4 y��:.� ri 1;1' � I�'h_ 3-+y��r' :��,^14�YY�br'f e "'-s ��t�-� N Fr`� , '�iR 5�� �s`� - ,-.,r. i :1✓ s F h z:"i s'4 4 r aYJ ,i '' S i s fir' L -4 k`t i b;" �: +'f. e a �' •Y S�x'A 3�c R �� � Y•,.#a" l4': r v t �r h� iS .. }'4 v',/ `,y °^flq.x � #j+ rCJ L,i: !iigraY rJi4a � Ffit' Yp r g, ' TOWN OF BARNSTABLE'.M , �(l ]•, � V � i ;mot 1 i •� � T 1i' �7 {Y'Sr.t ��1 r 1., A 5...d1 i� k r� p M1* - r, t - r I f fl ,ti} },il r,d{}jYi,ar-.rv`y a ��✓�! 0.� t}1 a. r 5�1q .r,Nq �,i OFFICE O i IIAH73TABli i ,, n? i >o ;.BOARD OF HEALTH : I o 1G39. e � 367 MAIN STREET ;t M = ,» 411 HYANNIS. MASS. 02601vi September 19, 1985 r i t , 'Mr. Robert F. Wheeler ' i 5 h 1 111 Goosepoint Road Centerville, MA 02632 ^ Re: Lot 13A/104 Goosepoint�Road, Centerville try 1¢" b,(�j s z 5 �,+} wr 1 0. -L t 4 1} lffritt, Dear Mr. Wheeler ,p • , , z t,4 .f {r .. +v't.. r..:k °M :+ ,�, � � S 7:Y� a You are granted a variance;,from'the'Board of Health Interim .Ground Water}Protection Regulation to � limiting sewage flow ..to 330;:gallons per acre, per day,,,:, within zones .of `contribu:tion`, with following conditions.'. The variance will allow .you to construct anon-site°sewage disposal'system ' on Lot 13A/104 Goosepoint Road, Centerville. , The.variance' is invalid .if;, the following conditions 3;Vx � -`cannot be met: ' (1) An engineering .plan -for the on-site sewage disposal system meeting all of the requirements of Title 5, of the State, Environmental Code, and'Town of Barnstable`Health Regulations ' other than the ;variance granted must be approved by the,Board prior to the'issuance;of building permit",,. .. (2) The designing engineer must,be on site and supervise construction} of the septic system ands certify 'in,:-writing to.ahe :;Board of Health.that his design has been`strictly adhered to prior to the issuance of a Certificate of Compliance. `(3) The dwelling must connect to the public water.system (4) This variance expires October 1,:1986. This variance is granted because it is one of the few. remaining vacant lots in .the area `he lot is 20,000 square feet a_nd it ,is'the opinion of the Board that the' construction-of an on site sewage disposal System will not significantly:affect groundwater-quality or;public health r v tI ly your , 7• a y }t . < i° t; 4 . z ert L. hil s, Chairman _:•'rb 54' 6 ,. fe; z ..;.'ay�5#dSd'�'.,h:�`� ,+''`.�r }'s1 t ' . r f Ann Jane shbaugh l r { fit sY.. t3. . a-•{� p + P , fi ,.- � , { r b ,} i 1 S '-',Ill; �M yt t 4.„Grover C.M. Farrish, 14 D Y k �BOARD.OF HEALTH + _<tr-TOWN OF BARNSTABLE Y ,cc: Down Cape Engineering a R�� Attorney M ichael'Stusse y _ i rR Ti'}•+ ,}., , Y f° t Y'�K�''Fi + a.'i� r+ s`c d k �� �9 Njs s �.p�4> '} _ r ` t<. �n-�y��•ras,�J', b, wK TOWN OF BARNSTABLE i LOCATION SEWAGE # *0 — /S/ . 0 VILLAGE CENITE,Q yiLLE' ASSESSOR6t�O'S MAP T ��� INSTALLER'S NAME PHONE NO. 4.c-d/ P�qr p yS/f/ SEPTIC TANK CAPACITY /00,0 LEACHING FACILITY:(type) LEOfe� . &T (size) NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER PU/S BUILDER OR OWNER_��1 /�(TA DATE PERMIT ISSUED:T�f DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 3 � N � 3 GooS Po�w?T Rof9D Postal mCERTIFIED MAIL,..,RECEIPT (Domestic Mail Only; For delivery information visit our website at www.usps.com. ru OF ! 1 AL m m Postage $ C3 Certified Fee Return Receipt Fee P Here ost (Endorsement Required) O Restricted Delivery Fee r=1 (Endorsement Required) 4 _ r C3 Total Postage&Pees. $ 7J o David Holt Today Real Estate 1533 Falmouth Road/Rte 28 Centerville, MA 02632 Certified Mail Provides:• A mailing receipt J (evenay)ZppZ aunp'oose w,oj sd ■ A unique identifier for your mailpiece IN A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be dombined with First-Class Mails or Priority Mails. 'a 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 Retum 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. in 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 MaH receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. j SECTIONSENDER: COMPLETE THIS SECTION COMPLETE THIS ON DELIVERY ■ Complete items 1,2,,and 3.Also complete . Signature item 4 if Restricted'Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we cari refum the card to you. p B. Rec —dlb-qly�ted Name) Date of Delivery ■ Attach this card to the back of the mail iece, l! ~ .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 - --.� - David Holt Today Real Estate ! 1533 Falmouth Road/Rte 28 3. Service Type Centerville, MA 02632 ❑cermed Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 0*6 ;0 81010 0 0 0 ►3`5 2 4 6673 (Transfer from service laben Ps Form 3811,February 2004 Domestic Retum•Receipt 102595-02-M-1540 i UNITED STATES POSTAL SERVICES meld" a �f°ifE"{iy.:fs�Mail9 I E'^.meld"¢72 � raw Id ,��`7' '`^t+"' r1- , .. -ry::`, ,•;r: .: i+ �C: a`w.»xi�<a+°' a i^��:n� .. .gym. I • Sender: Please print your name, addreJ-- and- lF%FKWt ; • o` s Town of Barnstable r�F, j Public Health Division 1 200 Main Streety Hyannis, MA 02601 1!I„:„1,1,11„li,,,,„IIII,111tt tt 1 t 11 Town of Barnstable Barnstable oFVE Regulatory Services Department . I �`'' MASS Public Health Division 1 �9. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 6673 October 8, 2012 David Holt Today Real Estate 1533 Falmouth road/Rte 28 Centerville, MA 02632 Re: 104 Goose Point Road, Centerville, The septic system located at 104 Goose Point Road, Centerville, MA was last inspected on 9/27/2012/by Shawn Mcelroy, a certified septic inspector for.the State of Massachusetts. The inspection of the septic system showed-that the system "Failed" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: 0 Septic system is in hydraulic failure You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER F THE BOARD OF HEALTH m c e , R.S. Agent of the Board of Health i Documentl r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. General Information 1. Inspector: �✓ Shawn Mcelroy Name of Inspector Upper Cape Septic Services Company Name 29 Atwater Dr Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that-the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and 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 f-a `:j-, , 9-27-12 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared sue' i.stemr d©r 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 I � t5ins•11110 Title 5 Official Inspection Form. ce Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts - N Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 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 exfrltration 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form . Subsurface Sewage Disposal System Form -Not for Voluntary Assessments GM .104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 17800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State 4 Zip Code Date of Inspection B. Certification (cont.) ' - 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: a ❑ 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. x 1.. System will pass unless Board of Health determines in accordance with 310 CMR I; 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 3 t5ins-;11/10. 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 °M 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real:Estate 1-800-966-2448) • Owner 'Owner's Name information is required for every Centerville MA 02632 9-27-12 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 Y2 day flow t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form 1 o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448)- Owner Owner's Name - information is required for every Centerville MA 02632 9-27-12 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. El ® 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- 1 0,000g pd. ® ❑ 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 El Area 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments b M 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? d ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 t5ins-11110 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 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: 8-2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): r 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: r t5ins•11110 Tide 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 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today ReallEstate 1-800-966-2448) Owner Owner's Name information is Centerville MA 02632 9-27-12` required for every page. Cityfrown 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: NIA 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 Elg e cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official .Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800=966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) " Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness _ 0 Distance from top of scum to top of outlet tee or baffle 6-1 Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage., Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete . ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 r i Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1987 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 54"feet Material of construction: ❑ cast iron • ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank(locate on site plan): Depth below grade: 48"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other ex lain 9 (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 Sludge depth: 12" t5ins-11/10 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 104 Goose Point Rd Property Address Bank Owned (Contact David,Hoft @•Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with stain lines above inlet invert. 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•11/10 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 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800=966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately -6 L,- O G O � V 3`G<< -30,a� 7 f" s 4 t5ins•11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 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: 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: 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: USGS and town maps show no groundwater at 12'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 104 Goose Point Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 9-27-12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater , ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file I t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 17 of,17 TOWN OF BARNSTABLE LOCATION /0' L6a-y 5e SEWAGE # _- VILLAGS ASSESSORS MAP& LOT INSTA II ETS NAME&PHONE NO. SEPTIC TANK CAPACITY ..�4 �LEACHM EA.CILI' , (type) (size) l- /0 0-0 c� NO.OF'B DROOMS..,_ BU LDER OR OWNER. j PERMIT®e4 TE:-___w_ CC�WLIANCE DATE: - I'( Separation Distance Between the: { Maximum Adjusted Groundwater Table to(lie Bottom of Leaching Facility Fees Privato Watr r Supply'Well and Leaching Facility (If any wells exist on site or viithin 200 feet of leaching facility) Poet Edge of.Wedand and leaching Facility(if any wetlands exi t within 300 feet Q }tf��.facila'ty),���� � fl�ec uritlshed by k /U! � G O � 045111 TOWN OF BARN�STABLE I LOCATION COOS /�0T �Pn�l./ SEWAGE # /S/ VILLAGE o1,� d 1T1 CE"`�rER ��� ASSESSOR'S MAP &LOT INSTALLER'S NAME & PHONE NO. / SEPTIC TANK CAPACITY LEACHING FACILITY:(type)_ (size) /DOD -.J/ NO. OF BEDROOMS_ PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER G;l 1,i¢,Q,c-"A DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No 4N i � 0 i Goose Polpir /Qdf�D r 362-4541 926 main street rt 6A yarmouthport mass. 02675 down cape engineering civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys 9 site planning April 13, 1987 sewage system designs John Kelly Town of Barnstable inspections Board of Health South Street permits Hyannis, MA 02601 Re: Lot 13A Goosepoint Road, Centerville Dear Mr. Kelly, I inspected the installation of the septic system for Gil Raposa, Lot. 13.A Goosepoint Road, Centerville and found it essentially in accordance with the plan as shown on the "As-built" plan enclosed. Very tr rs chard R. Fairbank, P.E. RRF/amp Encl. SECTION ® SEl, AGE _ rP770 it ?x�5> I -SEPTIC TANK- -"D"BOX- �' -LEACH Elf -- ti'i4L TOPpF FDNA '/ WASHED STONE •? :w. /", ---- �:.. � Y� '�, vlr-.V. IKOUT . . . �, - 45 I OUT• LN• V � ' Oi I (�� e m• f `` \ -' �i� �' SEPTIC LOT 12?� ELEV. TAN OGL3' p Z a i �# : 5' ELEV. ELEV. t r ELEV. � � �� / �f•.�� ---.�,�. • c w ELEV. ELEV. SIIDC7 � 66 . WASHED STONE 7t 11 Sa.o.� n1'K)VN 1 � TEST HOLE LO -� x �� . cs FAIRE3ANK G 1 `V 1 TEST BY r 1. / - 1�1 06�°i�. WITNESS 41 TEST DATE .. BEDROOM HOUSE:.' T.H. +� 2 v�d NIP,: —a-=— _->.[ ELEV. , ELEV. N U' ,L. DISPOSER DISPOSER - LOA g PERC RATE. zl MIN/IN.: ... I+ 1{ 5 'F LOW RATE.!�60-(GAL/DAY i! G Fit D. r• rw. °* \`L SEPTIfr -- TANK. - T` !, . Ll eo REQ DSEPTIC TANK SIZE v r - E Utz : LEACH LACI LITY- f SIDE WALL .5. I G/D.. 1 IAA c' . . � .. � ' „q, t ZrD -.. ... G ... .. � -.- ;� ,. - V� .. y.. T TA 63 ih Ah „v G'�,i E 1 USE: LEACHING! z � I '�• Y l r 7��E X let; eFy= I�.NI �.LL�WATER ENCOUNTERED' NOTES:' (UNLESS,OTHERWISE NOTED) 3.DATUM MS A M /� tJ i L7 ^Y, t• . ( L) T KEN FRO � �� QUADRANGLE MAP..; 2.MU I� NICIPAL WATER.' M . 3.PIPE PITCH:�4 PER FOOT .. - d. �;F ��E+2�T.. klTl�lt✓ CO�Gi"f�i 1GT to 4.DESIGN LOADING.FOR ALL PRECAST UNITS:AASHO• .b4 1�H'��` f •`.'. 1 r • !�. r•�YA14G . I. :' 1 ^,�, �. a{-1 ���F -lJ.� '4 S:MI N.GROUND COVER W F RO D CO ROVER ALL SE AGE ACILITIES:(1)FT. 6:PIPE JOINTS SFtALL BE.MADE WATERTIGHT :'' �' , -, '. 5 V 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITHCOMM. f H.' yG CO .OF ENVIRONMENTAL CODE TITLE S s ! v ;. ,. PLANR.:_ _ 13. T�-a�S 'pc.1a,�J FoL.'P'Cf.>7ey�Z0 .wC�tJC C�+�.`c �•.—a� S+-iO�J�� � t• s ;�Q't��'�r� - ► to-e— LOCUS: Fi�OI r' �i0A Q >/� t r EO �i. ALL. W T �q 1. _ - �: ____-, k GIa:I Util DPUG. QrYl !D�.. 1.1 �l.�V.S CX� _ , >,` 3``� �, �t:l>: REQtPRO O NGINEER, # U �J AA1 .., -: ': 1. yy� ��` � A t x G L� M�.� U M, r.•"-�lt �Z-. �,e� REF �irJ�►� .. ,. r., A-,: ,.. ., . ;Su� :,5t•-tee+ 1-. H 1'. Q► e , 1 1,1 tU LEAf.,4! z. * PREPAREDFOR" D'7�1 l'LJ ti -�-. CIVIL:.EN iN � 3 r.. G ....,.... ,- .a:^r ,.-., .. ...... ..... . ...:..... tea_,..,.... '"_.._ _ ._.:_.._ .... : ......, !''',� ,:..... _. ...•...:.,, r ... < h. .it a ., ... .°t. ,-,.... -,. .. : ,. .. .. , .,_.,<., .,. ,� ..LANOSURVEY � - ,,. � _. "_. . +:•._; -- : n, .h� �, ORS: i.. . .. Y BOARD' x OFH - ,_ v. ..x. REG- u �, ,. .: 5T ) CONTOURS �, .t^ . .,. ,. ;... •.: - PROPOSED -'O - . ;, . . .1,APPROVED - DATE - -, . �'r� SCAt��' *., 4 ' - UA CD SECTION = SEWAGE T .� -SEPTIC TANK- -"D"BOX- �I -LEACH- `p I f TOPQ�F FDNf (MSL)r .. . ( r,*001 2"OF ISTO y=. ) yam WASHED STONE .�Z ��l• rwV V. Jill y v T � CAI o � S �•�`'�/// 't�- �! f��AKOU IN- OUT- N. 51-yv SEPTIC ELEV. TANK �' \\ ^ ELEV. ELEV. / Co ( f \ t // \ �elou� GCS' NG� �J.1.231,5 ELEV. ` ELE�I'. ELEV. ��OLD \��• l �" -WASHED STONE TEST HOLE LOG. elev Q TEST BY WITNESS # TEST DATE DESIGN .. BEDROOM HOUSE T.H: • 1 T.H. +� 2 I7�i A � rva a --LC ELEV. >��^ `\� �,� t a u DAll3 PERC RATE. MIN/IN.- DISPOSER DISPOSER \ r �1 /� � \`•fie` �; ` ``'\-� GA DAY FLOW RATE 3 t w ) B. / . KL li n _ G• EA �f- \ SEPTIC TANK U co REWDSEPTIC TANK SIZELIE is o \ h E I U Ta F I E u p LEACH FACILITY SIDE WALL I/�i['G 1 .185•S (2.5) . L Z .G/D. G� A� •\\ �S•T 80TTOM �Zr - ,�i r�.r� ) _ 7P..S G/D: TOTAL .Q USE: O)�I�.. LEACHING f IT I N- o , WATER ENCOUNTERED' NOTES": (UNLESS OTHERWISE NOTED) 1.DATUM(MSL)+TAKEN FROM f�JJ/�A1._L Lj 1 Ll7 � QUADRANGLE MAP.: tom•/� -T 2:MUNICIPAL WATER I y. AVAILABLE (rl1 Ee"re�' W ITU C�T� �P��,�1 1zLAGT IO 3.PIPE PITCH:%"PER FOOT TN't�f. nA 4.DESIGN LOADING,FOR ALL PRE-CAST UNITS:AASHO• -44 �� 4 E� zpALv_v w IT N v[� C�Z��b S.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES:(1)FT. �� �, -- (-'OAZ�r�Ta. Qr_E_ 6:PIPE JOINTS SHALL A MADE WATERTIGHT �`r - ARNE t� �G 1 OATED �/l�i�ejs 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. �,4 OJP Lq ,v'., - �+1TC PLAN y /� r.- STATE ENVIRONMENTAL CODE TITLE S r -r ( 1 SITE .1 G PLA 8. T�-i�S p:_.&` F4'G 'P't!>' .� �.�oZJC C��``C /r.ad S+-W�J�� ►-�o-r- �E u � PaZ. '.�ctc�cz�•C t_„+G �r-a.��•..►c� . a Cam"( •7 LOCUS: G{��L�iI�O(�1' 9. ALL UlliITAP_j r,- "t4A�TEfJPL�Tu�A�t'j SLEN.S1•Cxo . — ��'�'— of a��q�y G�i1TF.R��LL� A,U0 ELVV, 151.00 TO PcE Z,WMeT>AW P REbz]Q}R�F„�ESS10 ENGINEER a ARNE _. I + 71Aoff 2,(� ,fit �. W 114.GI,�L\ �t7t M Gl,Ei� �0� I ! H` REF: I�IAr:,lroY '!�t-I r'Av�E �. M u 'ro o ; rdown cape engineeri/^����^ I PREPARED FOR: I I Few u MD i Dtf l-1.(t�((y - CIVIL ENGINEERS -- - RV _ i BOA HEALTH x r 3 BOARD OF., (EXISTING)............. t NG) - .. �,� SURVEYORS CONTOURS APPROVED DATE IJA YI 11hTAOJL AMA +: !r .r - ti SU (PROPOSED)--0-0-0-0- .f' .RE XpR I oAd8 ,�_ LEGEND CENTERVILLE PROPOSED CONTOUR -,- GO .0 ® PROPOSED SPOT GRADE "- G2 R O� -- 98 -- EXISTING CONTOUR " TF + 96.52 EXISTING SPOT GRADE 64 goo '32 W— EXISTING WATER SERVICE LOCUS O�O�o% TEST PIT / T GG G8 4 LOCUS MAP I LOCUS INFORMATION 6 -:r� "Ports vent +- TH-.2 �152 TITLE REF: 5283/147 O i1 PARCEL ID: MAP 252 PAR. 046 �.o O _ TH_I 59.7 ------ c,0 O� o SEPTIC SYSTEM EXIST. LEACH PIT REPAIR PLAN see Note 1 0 LOCATED AT: 0� �o 104 GOOSE POINT RD. 0 I .0 CEN TER VI LLE, MA GENERAL NOTES: PREPARED FOR 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 5��'J\ D E D E C K 0/FNMA 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS ���- ; 3 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE �P 6 JANUARY 8, 2013 LOCAL RULES AND REGULATIONS, EXCEPT AS NOTED BELOW: REV: JANUARY 10, 2013 —310CMR 15.405(1)(b): O 58.2 1) A 0.35 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW +�J LEACHING TO BE 3.35 FT. BELOW GRADE VS. REQ'D 3 FT. (H20/VENT PROV.) r 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR OF �9ss9�y TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. Z G DA`RRE M. �r 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING Y FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. f N0 0 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OFTHE OR OWNER TO NOTIFY THE LOCAL HEALTH FORCTOR PROPER INSPECTIONS DURING CONS UC IOND OF a N I TAR�a� 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. EXIST. I ,000G ~I Jam' IL�lO 1� 8. ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED SEPTIC TANK TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. r 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY I MEYER 8c SONS, INC. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. I 10. EXISTING PITS TO BE PUMPED AND FILLED W/ CLEAN MED. SAND k P.O. B O/� 9 81 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION I 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY j EAST SANDWICH, M A. 02537 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 150 FT. OF PROPOSED LEACHING 14. ALL PIPE TO BE 4" SCH 40 0 1/8"/FT (UNLESS SPEC. OTHERWISE) g {5 0 8)3 6 2- 2 9 2 2 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OF A GARBAGE GRINDER 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 17. PROPERTY IS WITHIN A GROUNDWATER PROTECTION DISTRICT SCALE 1"=30' SHEET 1 OF 2 J 1449 NOTE:'TO PREVENT BREAKOUT, THE PROPOSED , NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:59.04 FOR A DISTANCE OF 15' AROUND THE i I PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. T.O.F. EL.=69.0 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER 14" • OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN:) AND SET TO 3" OF F.G. � INSTALLED F.G. EL OUTLET F.G. EL.=64.5t F.G. EL: 64.5t F'!G. EL: 65.0(MAX.) VENT LENGTH 0FDA �gsfq� 9.45 ' 9" MIN COVER/ M ° L = 10't 36" MAX COVER L = 15' L = 10'(MAX) INSTALLJTWO INSPECTION PORTS (MIN.) O. 1140 0 S=1% (MIN.) EL. 60.50 ® S=1% (MIN.) 0 S=1% (MIN.) 12.37' 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 1 ,p. 10'I S1F�O 14" s 10.75" TO \INV.=59.50 48" LIQUID INVERT SANITAR�a* INV.= 59.0 INV.= 58.58 b 10 1� LEVEL r COUPLER DETAIL I PROPOSED 1 GAS BAFFLE D-BOX INV.=58.68 4 ROWS OF 4 UNITS ® 5'/UNIT + 3 COUPLERS ® 1.16'/UNIT = 23.48'/ROW INV.=58.8 DQ- SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK EXISTING SEWER OUTLET RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND TO TOP OF CHAMBERS 60' NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING BREAKOUT=TOP ELEV.=59.04 PIPE INVERTS PRIOR TO CONSTRUCTION INV. ELEV.= 58.58 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BOTTOM ELEV.= 57.71 GRADE ON A MECHANICALLY COMPACTED SIX EXISTING SUITABLE INCH CRUSHED STONE BASE, AS SPECIFIED IN 2.88' MATERIAL 5' MIN. ABOVE BOTTOM OF 310 CMR 15.221(2) T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH 4 x 2.88' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK (5.21' PROVIDED) USE 4 ROWS OF 4-ADS ARC 36HC WITH 1500 GALLON SEPTIC TANK IF FAILED, ADJ. GROUNDWATER EL.=52.50 - (H20) UNITS NO STONE W/ 1 COUPLER DAMAGED, NOT H2O LOADING, OR UNDERSIZED. IN BETWEEN EACH UNIT 4) INSTALL INLET & OUTLET TEES W/ GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE TYPICAL SECTION N.T.S. 16" N.T.S. DESIGN CRITERIA SOIL LOG P#:13832 I DATE: JANUARY 3, 2013 NUMBER OF BEDROOMS: 3 BEDROOM DESIGN SOIL EVALUATOR:I DARREN M. MEYER, R.S., CSE #1614 SECTION i10-75 SOIL TEXTURAL .CLASS: CLASS I DESIGN PERCOLATION RATE: <2 MIN/IN WITNESS: DONALD DESMARAIS, BARNSTABLE BOH HEIGHT END CAP DAILY FLOW: 110 G.P..D/BR. DESIGN FLOW: 330 G.P.D. Elev. TP-1 Depth Elev. TP-2 Depth ADS - ARC 36HC CHAMBER (H20 LOAD GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 66.0 0"1 66.50 0" A LOAMY SAND A LOAMY SAND SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK 10YR 3/2 10YR 3/2 MODEL ARC 36HC l; 65.25 B 9'; 65.75 B 9 LENGTH 63" LOAMY SAND LOAMY SAND NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT IOYR 5/8 10YR 5/8 EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. 63.18 C 34" 63.68 C 34" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE. MEDIUM-COARSE MEDIUM-COARSE SIDE WALL HEIGHT 10.75" DISTRIBUTION BOX: 5 OUTLETS (MINIMUM) PERC ® 61.17 SAND SAND OVERALL HEIGHT 16" 84 PRIMARY S.A.S. 59.0 59.50 84" 2.5Y 5/4 2.5Y 5/4 OVERALL WIDTH 34.5" 4640 TRUEMAN BLVD "USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE C2 MEDIUM C2 MEDIUM 10.7 CF HILLIARD, OH/O 43026 AND EXTENDED 1 16' W/ 3 COUPLERS IN EACH ROW SAND 1 SAND CAPACITY 80.0 GAL ADVANCED DRAINAGE SYSTEMS, INC. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) 2.5Y 7/4 I 2.5Y 7/4 PROPOSED SEPTIC SYSTEM/SITE PLAN (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF (COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.81 SF 52.50 162" 53.00 '62' 104 GOOSE POINT ROAD, CENTERVILLE, MA TOTAL AREA = 450.81 SF PERC RATE <2 MIN/IN. (-Cl- HORIZON) Prepared for: Dedecko/FNMA DESIGN FLOW PROVIDED: 0.74GPD/SF(450.81 SF) = 333.59 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED Engineering by: Surveying by: SCALE DRAWN DATE: Meyer&Sons,Inc. Heller & Assoc. NTS D.M.M. 01/08/13 • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX981 (508) 375-0735 to conduct soil evaluations and that the above analysis Gas been performed by me consistent with the EAST SANDWICH,MA02537 REV. DATE: CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. 508-362-2922 01/10/13 D.M.M. 2 of 2 r