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HomeMy WebLinkAbout0407 GREAT MARSH ROAD - Health 407 GREAT MARSH ROAD f III__��_/J J�gECYGtFOCo IIII © � ym UPC 12543 0 "No. 53LOR ""o'er co HASTINGS, MN TOWN OF BARNSTABLE LUNATION yT�! Cry N SEWAGE# J11 ' VILLAGE�f�b/�t� <p/I ASSESSOR'S MAP&PARCEL /9O ICI INSTALLER'S NAME&PHONE NO. D. k® �-� A-J DrA, SEPTIC TANK CAPACITY 60 LEACHING FACILITY:(type) (size) NO.OF BEDROOMS 3 OWNER PERMIT DATE: 7� 1�J/ COMPLIANCE DATE: .� Separation Distance Between the: ,I Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Welland 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 L -� 2F' . 3 S� �- Fj o � No. v -' Fee r THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZippliCation for 0spo8al *pstem Construction Permit Application for a Permit to Construct( ) Repair(Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 1Yd7 671l9a _ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel go f 5 L J Ct / ej Installer's Name,Address,and Tel.No. _ Y:,?4o P-r 9'd'7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 6 gpd Design flow provided 3 j�A gpd Plan Date Number of sheets Revision Date Title /�, Size of Septic Tank Type of S.A.S. 6L) 57R) t �f�r+~�1�� f to � we Description of Soil Nature of Repairs or Alterations(Answer when applicable) /vim j9 ✓,< -Lj.. 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 Heal . __ Sie Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued ` Cy No. a W� Fee / F THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I/ Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4plication for Misposaf .6pstem Construction Permit Application for a Permit to Construct( ) Repair �Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components a . Location Address or Lot No. y� d7�esi.s� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel o o!l�P Installlller's,Name,Address,and Tel.No. pS���6�/`�r f7 Designer's Name,Address,and Tel.No. ,S/al.�Un lJ w o J G✓` pro"" Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) -V 6 gpd Design flow provided 33d gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil a Nature of Repairs or Alterations(Answer when applicable) /�'�Gv ® /'. �e w. T Cf� 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 Heal Sigged _ Date c� Application Approved by �/(�__.__ Date Application Disapproved by _ t Date for the following reasons l Permit No. /'�' g Date Issued -" - _ - --- -- -=------ =--- -- _- - - - - - --- -------------- ------------------- - ----------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �)'i Upgraded( ) Abandoned( )by QIigk 'a..-.e I'ar,it at 'l 1.4 T 6-f 1'G•�' d�/r✓ �� �i� ,.has been constructed in accordance with the provisions of Title 5 and thefJ � 3-br Disposal System Construction Permit No. ;0�9 -0ated 11"I f Installer /'//G �° t �ii0' � "- ,t ''�-' Designer kr, 'p #bedrooms Approved design flow _ gpd The issuance of this permit shall not be/construed as a guarantee that the system w-ilI-fimction- s esigned. Date j -/) Inspector -------------------------- _ No. Lam- Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal bpstem Construction Permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at 'y� �7 �Cu XI2 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 completed within three years of the date of this permit. --7 Date �-, '`��--( Approved by ..,� '� A . .. Y J r 1 v aFa ! v tit#erl�I Direct©�- Y Pub�i� Ilealt�Dx�risx i � 3 ryry 1V[cKean DIr�.Ltor 0�,'Yta�n Stl eeE,20 ,�� �Hyarrills A Q2GQ3 fi /Off, ` Il�staller�.Desl€�ner Certi�:etlrzol' �o m E Sewa a Perm� Assessor's I�7ap1i'arcel� `� ;`�l 3 Dcslgper nx {;a1 < < . I47�; ltistallel:, �� ,,- Address �1ddt C Z ess� ;; c�-✓t d +�we✓ a �� .�i�J, ass r �l c/ r �� �5 �,n.-�✓x-f-- ��., 3 was is��tccl a}�eruut„to install a (tnstallt?r) s�pttcsystran at � bayed on,a design drawn by v (address) � dated �r� (desrg>iet)" �ert�fy th�a(`tlae septrc sys.em Iefetenced:abo�>e;was�installed�Substafiti��iy aecotdrna�to ' ngs the design whrch ri�ay include t�unor appro�ed'chaes uch"�s lateral relocation of�,the dlstnbutton`box andlor sepftc tank r�tn�i out (a'f recluii'ed� was t,nspeetecl.anal the"'s•'or[s were`;' d oun -satrs-facEol t I cety that;the septic. Sy�tent referencecl�abo�e vas iristalled:��tYth tna�or changes,(t.e. greater than 1`f)' lateral relocation c?f the St15 or any ertt4al ie)ocattin of auy com}iti cnt" of the septic�sysfem)but tn-,accordance with State � Local Regtlattons Plan;revtstdn c Ittfi'ed as Bulk by ciestgnet to F�tlow Step outtiFreclu`tred� �;as,inspected artdthe sorlS fwere�oundsatisfacto�y; � � > f , 1 ce1tl,Fy thgtthe system re£vrenCed above vas construetcd �, with the fetzn of the;t! Tiro �Ce ft a ` licab[e) j t (hnstalter's Slg�attu-e) � � � CtU1u�Gg � v ' F � signer s Stgnatu�,e) � (Aftrk Desrgiie PLEASr R�TURl�` T4 13ARt�iS'I ABLE PUB,L.1C HEALTH 1)Itri"StQiV.;. CER�-IFICA'.TF. ©F COMP"LIANGE V'a'IIL .l\01 liE AISSIJE!D UNTIL 'BOTH, THIS FOt2M >Ai�TD,=AS Hh`ILT C1-IZD �R� L�EI'G EII4'B TFtE BA��S�ABGE'rUBLf:C. HCA`LT�N , ' 1H2li�rk,l'OU , .. s ` 7 (j sepia uesranpt Certificctian Feaiiii ite v 8 t.t l3 dti f / ErSgigeiis Hate This cerldacatmn�s-limited fo an�s b{�j{'jnspe Uan:at sys,em components as installed onoc'to bacl<fill The' engineer d d z of supsnnse construction of the-syster*� Tye in,ai�'sr assumes eesponstbilay or�!f rn enats:;warxinansni uackr t in taspeeded�rades with pros r compac,on-�,.d`sett�ig �sgr lccvei§'as shop+riaori°th"e destgn.plari; , Town of Barns taule r# ( cis. y� Department of Reg►latory Services , .+ .� ]Public Health Division Date LZD . 200 Main Street,Hyannis MA 01601 h f r t-, Date Shceduled - Time /�V .Fee.Pd. � �-.�' � c 00 Soil Suitability Assess m+ent o� . tJ' f. e 17rs osal g Performed By: joe4c'- �C-��-ck /S�/Z- r Witnessed By; LOCATION& GENERAL INFORMA�TsIONI )�� /� Location Address F,rO7 r'-�g�—fl'IC( �1 Owner's Name lq✓f J6"ACttl /Z50Z OV .� Address -7 El wt S r jA,?Q S k r., a_rC !�A- l -Z-6 i Assessor's Map/,Parcel:. 19 0-1 q j Engineer's Name F�yl 9 j✓I WV- n5 0 tj NEW CONSTRUC`T�IOIN�/ REPAIR _ Telephone`# Land Use' Slopes(TO) , � Z- Surface Stones Distances from: Open Water Body 2 -cf ft 'Possible-Wet Area Aift. Drinking Water Well ft Drainage Way-./Jjj�= ft Property tine 2A ft Other ft SKETCH:(Street name,dimensions of jot,exact locations of test holes&'pert tests,locate.wetlands In proximity to holes) q) Q�Z✓-L Parent.material.(geologic) `' `Sr�� Depth to.Bedrock. . Depth to Groundwater. Standing Water in Hole: ( e1 r Weeping from Pit Nce Estimated Seasonal High Groundwater. L DETERMINATION FOR`SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in ohs:hole: __ in, Depth to soil Mottles: it). ,._ Depth to weeping,frnm side,_ef nbs.hole: � _. � in: 0rottniiwutci'Ad,"s3ttrlent .� ��-It. Index Well# Reading".Date: Index Well level Adl,faetor _•Adf.t7roundwnterl�vel—; PERCOLATION TEST Date Thne .� Observation Hole# 1 Time at 4"' „ Depth of Pere l y S Time at 6" ,, Start Pre-soakTime,@ ..l,S n� ''rime(9"-6") End Pre-soak h Rate Min:/Inch Site.Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health.Division Observation TIole Data To Be Completed on Back----------- t ***If percolation test is to:be conducted within 100' of wetland,you Ynust first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. Q:1S EPTIC\PERCFORM.DOC DEEP OBSERVATION BOLE LOG Hole#, a. Depth from Soil Horizon Soil Texture Soil Color Suit Other Surface(in.), (USDA). (Munsell) Mottling '(Structure;Stones,Boulders.. o i ten r vel L. Cc 72.—IZo CZ__ Mgt 5�, 2-s`f !� S -5,ra. l DEEP OBSERVATION HOLE LOG Hole# Z— Depth from Sol]Horizon Soil Texture Soil Color Soil. Other Surface(in.) (USDA) (MuMell) Mottling (Structure,Stones,Boulders. / Cons"stency.% ravel DEEP.OBSERVATION HOLE LOG Hole# Depth.ffom Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) _- ; (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, Gravel) - t DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil C61or Soil Other Surface(in)- (USDA) (Munsell) Mottling (Structure,Stones,Boulders; Con'1 n r Flood Insurance:Rate.Map: Above 500 year flood boundary No_ ' Yes Within 500•yearboµndary No Yes r Within 100 year Flood boundary No Yes. Depth of Naturally Occurring Pervious Material Does at leastfour feet of naturally occurriilg`pervious. material,exist in all areas observed throughout the area proposed for the soil absorption system..l If not,what is the depth of naturally occuming pervious material? .. - ' Certf cation .. - I certify that on C^ (Ci (date)I have passed the soil evaltiator examination approved by.the. Depamnent.of Enviro.nmental'Protection and that the above analysis-was performed by me consistent with -the,required trainiag,expertise and experience described in IQ CMR 15.017. Signature 1. Date Z- ( ( (ck_ QAS,E?TlCTERCFORM.DOC MIRM oF`"E'�w Town of Barnstable F{ Y ' U.S.POSTAGE>>PITNEYBOWES 1 Public Health Division �+ �� Y# BABNSTABLE. •r•• / - ��+� NABB. $ 200 Main Street �p�FD MP�Pe Hyannis,MA 02601 i -' _ ZIP02 02601 $ 006.67� VV 0000336455 SEP., 19. 2018 7015 1730 0001 4987 9149 DE SOUZA, HERMANO J r1/1AM- R� My R EOuEs RET"RN TO S=rSDE NOT DELIVERABLE AS ADDRESSED TO �-ORWARD y ,.�1TF t 31`a t . - :. .r�';-�s��=�,srm��e••'� `�,-=' s,i,; „llt it„! 11! �ll�,,,,��, l�,�I�,[� ,IE,o!„! t� l319:�.� 6 roc ov.a.r-rreroc ` °S{ � 'I"�"'99i�{ll� !I f! ti i•... {...iI..IPPi'l ld8'17E it • • COMPLETE • ON DELIVERY v\ 3 ■ Complete items 1,2,and 3. A. Signature - " ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ■ 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. 1. Articl D. Is delivery address different from item 11 ❑Yes { If YES,enter delivery address below: ❑No DE SOUZA, HERMANO J `p` h 407 GREAT MARSH ROAD f CENTERVILLE, MA 02632 II�'�I'I I'�I I�I I II(I I IIII I III II III'I I I I III 3 Service E Adult e❑ dull Signature g El Delivery Rregistered Mail Restricted 9590 9402 3759 8032 3748 83 ❑Certified Mail® Delivery Certified Mail Restricted Delivery 1q9 Return Receipt for ❑Collect on Delivery / Merchandise 2- GHiriA_NufnbeL(Tfd!ISfe/from Service label ❑Collect on Delivery Restricted Delivery 0 Signature ConfinnationTm _ -- —__ �I ❑Signature Confirmation `7 015- 17 3 0` 00101 4987 91,49 GI Restricted Delivery Restricted Delivery , PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt °F SNE Tpk Town of Barnstable Barnstable ti Regulatory Services Department A&AmericaC j RA 'STABLF- MASM Public Health Division 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#7015 1730 0001 4987 9149 September 19, 2018 DE SOUZA, HERMANO J - - - 407 GREAT MARSH ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 407 Great Marsh Road, Centerville, MA was inspected on 08/06/2018 by Michael DiBuono, 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 the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas.McKean,R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\407 Great Marsh Road Centerville.doc YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the-Business Certificate that is required by law. fj ` DATE:O Fill in please: AJ APPLICANT'S YOUR NAME/S: YOUR HOME AD RES BUSINESS �TE�LEPnHON # � _'me Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? >< YES NO ADDRESS OF BUSINESS O L MAP/PARCEL NUMBER L V r ` (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and-regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd.& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in his town. 1. BUILDING COMMISSIONER'S OFFICE Irl This individual has ormed o ny permit requirements that pertain to this type of business. MUST COMPLY WITH HOME OCCUPATION Auth e tur RULES AND REGULATIONS. FAILURE TO COMMENT OMPLY MAY REULIN 1 la: 6n I r` d2AdccX._r]s,, 2. BOARD 0 EAL H This individual has been informed of the e it r 'r me t at pertain to this type of business. ` MUST COMPLY WITH ALL Authorized Signature** HAZARDOUS MATERIALS REGULATIONS COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: sr s! R III TOWN OF BARNSTABLE Date:OP/©j / TOXIC AND HAZARDOUS MATERIALS REGISTRATION FORM NAME OF BUSINESS: BUSINESS LOCATION: W19 INVENTORY MAILING ADDRESS: Mae op p TOTAL AMOUNT- TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: 3-p 2Ql 9 S I MSDS ON SITE? TYPE OF BUSINESS: N INFORMATION / RECOMMENDATIONS: Fire District: Waste Transportation: Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month re uires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED - Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison" labels. (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): Metal polishes Laundry soil &stain removers (including bleach) Spot removers&cleaning fluids i (dry cleaners) Other cleaning solvents �! Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Applicant's Signature Staff's Initials oFVE r� Town of Barnstable Barnstable Regulatory Services Department BARNSWILL AlAmedeaCity "MIMM . ,m� Public Health Division • M 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#7015 1730 0001 4987 9149 September 19, 2018 DE SOUZA, HERMANO J 407 GREAT MARSH ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 407 Great Marsh Road, Centerville, MA was inspected on 08/06/2018 by Michael DiBuono, 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 the house due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\407 Great Marsh Road Centerville.doc Town of Barnstable • anxtvsrnst.E, - 9�A039, ,�� Regulatory Services Department ren r�A't" Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ,$ackup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc lqo l �l c Commonwealth of Massachusetts -- -� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's NameE information is 1:�. required for every Cenetrville Ma 02632 8/6/18 . page. Cityrrown State Zip Code Date of Inspection - Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information filling out forms Slz* /3aqV on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane kCompany Address Cotuit Ma 02635 City/Town State Zip Code B 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 8/9/18 Revised 9/17/18 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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 1 cam, Commonwealth of Massachusetts 11 Title 5 Official Inspection Form - I a Subsurface Sewage Disposal System Form Not for Voluntary Assessments 407 Great Marsh Rd u- Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 816/18 required for every page. 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: ❑ 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: System contains a 1000 Gallon septic tank as well as a concrete distribution box and a concrete leach pit. All show signs of failure 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): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 , Commonwealth of Massachusetts j p Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville F Ma 02632 8/6/18 page. Citylrown 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): I 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 1 C Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd v Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 8/6/18 required for every page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) El Cesspool is within 50 feet of a surface water pool or privy Y ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system.has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I e Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd �V Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank mpholes 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 pP P ) I O] I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �' la Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd �V Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 .8/6/18 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: System contains a 1000 Gallon septic tank as well as a concrete distribution box and a concrete leach pit. All show signs of failure Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 118 Gpd 9 ( Y 9 (gp ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityfrown 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): 3. Pumping Records: Source of information: Not Provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.1/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known)and source of information: Original to home Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1.5 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.): Vented at the roof line t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �/ 407 Great Marsh Rd V Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 ' P Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 30" ' How were dimensions determined? Tape Measure Comments(on pumping recommendations inlet and outlet tee or bafflecondition, structural integrit y, liquid levels as related to outlet invert, evidence of leakage, etc.): Should be pumped at time of repair t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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 Shows signs of back up into component 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 8/6/18 required for every page. Citylrown 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: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owners Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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.): 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c� Commonwealth of Massachusetts j p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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: ❑ hand-sketch in the area below ® drawing attached separately l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: TBD at time of perc test Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 C Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts :L 3, Title 5 Official Inspection Form = ? Subsurface Sewage Disposal System Form Not for Voluntary Assessments r / 407 Great Marsh Rd c , u� Property Address Caribbean Realty ; Owner Owner's Name ? information is required for every Cenetrville Ma 02632 8/6/18 page. City/Town State Zip Code Date of Inspection w Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 5X#_ 13-2gct on the computer, use only the tab Michael DiBuono key to move your Name of Inspector cursor-do not DiBuono Sewer And Drain use the return Company Name key. 35 Content Lane Company Address Cotuit Ma 02635 fA City/Town State Zip Code 508-364-9587 SI 13522 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 819/18 Insp ctor'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 has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 kb l WVX Commonwealth of Massachusetts ? Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System contains a 1000 Gallon septic tank as well as a concrete distribution box and a concrete leach pit. All show signs of failure 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): l5insp.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 4� �u 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityfrown 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: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. 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 ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd w-� Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form = �a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110,gpd x#of bedrooms): 330 Description: System contains a 1000 Gallon septic tank as well as a concrete distribution box and a concrete leach pit. All show signs of failure Number of current residents: Vacant Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonaluse? ❑ Yes ® No Water meter readings, if available last 2 ears usage 118 Gpd 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form , R �r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown 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): 3. Pumping Records: Source of information: Not Provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .V 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 8/6/18 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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): Approximate age of all components, date installed (if known) and source of information: Original to home Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: ee 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.): Vented at the roof line t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gallon If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: 3 Distance from top of sludge to bottom of outlet tee or baffle 24" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 42" Distance from bottom of scum to bottom of outlet tee or baffle 30" 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.): t5insp.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 I o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 8/6/18 required for every page. 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 t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts 19 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments P. 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm a resent: El 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 Shows signs of back up into component 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form to Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. 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: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 407 Great Marsh Rd �,. Property Address Caribbean Realty Owner Owner's Name information is Cenetrville Ma 02632 8/6/18 required for every page. 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.): 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form �= a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. 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.): t5insp.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 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information equir for is every Cenetrville required for eve Ma 02632 8/6/18 page. Citylrown 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: ❑ hand-sketch in the area below ® drawing attached separately t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts alb Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form-Not for Voluntary.Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name information is required for every Cenetrville Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 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: TBD at time of perc test Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts ,�.p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 407 Great Marsh Rd Property Address Caribbean Realty Owner Owner's Name required for is every Cenetryllle required for eve Ma 02632 8/6/18 page. Cityrrown State Zip Code Date of Inspection .E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ❑ A. Inspector Information: Complete all fields in this section. ❑ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ❑ D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I 8/9/2018 20180803_104043.jpg X �F. Ui�rrnenea Qr � Y� �� F ✓s9 to ail w,i s thin 100 fLocate where u[�he, er ��RIY cr�a �ntio I u )' ;;- mn � "NOW'IN ME'MZW A Dig, oil / MM "v�f f d KFk 4 iO ON vgg Mo � t n � � 4 9j \ T E / r r A q, sr https:Hmail.google.com/mail/u/0/#all/1652Oe2f39295eaa?projector=1&messagePartld=0.1 1/1 Certified Mail#7006 0810 0000 3524 8417 P�ppSHE Tp Town of Barnstable p� Regulatory Services f + I1ARN5TAF3LE. gap MASS. $ Thomas F. Geiler,Director 1639. A'f°MAC Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 . Office: 508-862-4644 Fax: 508-790-6304 February 14, 2007 Hermano DeSouza 407 Great Marsh Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II — MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at 407 Great Marsh Road, Centerville was inspected on February 13, 2007 by Thomas McKean, Health Agent for the Town of Barnstable. This inspection was-conducted on the basis of a complaint received by the Health Department. The following violations of the State Sanitary Code were observed: 105 CMR 410.350 - Plumbing Connections. Too many bedrooms observed for the capacity of the septic system. Five bedrooms observed when septic is designed for a 31l I� maximum of four bedrooms. ! 105 CMR 410.482 - Smoke Detectors. Smoke detector in basement inoperable. The following violation(s) of the Town of Barnstable Code were observed: 1 70-10- Maintenance of Smoke Detectors and Carbon Monoxide Alarms.No carbon monoxide detector provided. QAOrder letters\Housing violations\407 Great Marsh Road.doc I You are directed to correct the violations listed above by March 1, 2007 by removing one bedroom (by removing a wall or partial removal of a wall between bedrooms); by installing carbon monoxide detectors on every habitable floor; and by installing an operable smoke detector in the basement. 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. 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 OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Building Department QAOrder letters\Housing violations\407 Great Marsh Road.doc 0X'J0NWFALTg I � OF SSAC ExECUTrVE OFFICE OF ENVIRO SETTS DEPARTMENT OF ENVIRON NMENTAL AFFAIRS MENTAL ,PROTECTION 1 OFFICLAL LNSpECTION FO&yI TITLE 5 SUBSUI2F'ACE SEWAGE OOR VOL�TARY AS AL SYSTEFORM MENTS pART A l /Property Address; ? O CERTIFICATION Owner's Nam; h Qc Owner's Address: a %h 4+� �OZ G �,� o Date of Inspection: _ Name of Iaspeor. ' leaseprint) Y tree• Compare Na i !Mailing Addy c„ Address" cn Qo c ? - fir: Telephone 1Number: ge Dd 6 CERTIFICATION STATE NENT I certify that I have Personally below is true,accurate and co Inspected the sewage dispose system at this u'amMg and experience in Mete as of the time of the address and that the information reported approved system ' Proper fimction andPection.The Inspection was performed based on my inspector Pursuant to Section°f on site sewage disposals ste 0 of Title 5(310 CM 15.000 ms"I am a DEP —_ Passes ), y - The system: Conditionally passes __ Needs Further Evaluation b= the r __, , Fails y"•` A.Ocal Approving Authority. Inspector's Signature: The system inspectors Date:-` — hall submit a copy of this d iwithin )0 days of completing this inspection_ report to the A greater, the inspector pection_If the system is a shared Authority(gourd of Health or DEP.The on and the system owner shall submit hared system or has a design Feral should be sent to the system owner the report to the appropriate regional flow of 10,000 authority and copies sent to the buyer,if a Office of the Notes and Comments• applicable, and the approving This re rt Only des time. This inspection does not conditions at the time of inspection and under th conditions of tSeaddress how the system will a conditions of use perform in the future under the same at that me or different Titlespection Form 6/15/2000 page 1 I Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSLRFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property address: -T �4 �*^f/ 1 e el "�� d Owner: Sa (h Date of Inspection: Inspection Summary: Check A,B,C,D or E!ALWAYS complete all of Section D A. System Pa , 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 J repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,'v,ND)in the for the fol owing statements.If explain "not determined"please 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 exfatration 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. ND explain: 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 obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if with a ) y ( approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Titto i Incnu`rinn 7 nrrr F./7�/7f1!}n 2 rage of 11 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASS ESSI SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORMNTS PART A CERTIFICATION(continued) Property Address: ( � Ile Owner: �er l/ or h 3� Date of Inspection• _ 60 6 C, Further Evaluation is Required by the Board of Health: /'v Conditions exist_which require further evaluation onm by the Board of Health to order to determine if the system g p P th,safety or the environment. I. 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 ?. System will fail unless the Board'of Health(and Public Water Supplier,if any)determines system is functioning in a manner that protects the public health,safety and environment: that the The system has a septic tank and soil absorption system(SAS)and the SAS is within surface water supply or tributary to a surface water supply 100 feet of a, _ 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 we1L _ The system has a septic private tank and SAS and the SAS is less than 100 feet but 50 feet or more from a water supply well".Method used to determine distance "This system passes if the well water analysisndica,performed bacreria and volatile organic co ° y erf°rme at a DEP certified laboratory,for coliform the presence of ammonia nitrogen and nitrate to s en is a t the well is free or le 5 from pollution from that facility and failure criteria are triggered.A copy of the analysis ust be attached to this fom2. provided that no other 3. Other: Tiria i in-narrinn �nrm�il7 S/')(fin 3 Page 4 of 1 1 . OFFICIAL INSPECTION FOXM—NOT FOR VOLUNTARY SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM, NTS PART A CERTIFICATION(continued) Property Address' T 0 Owner: Se, /,n Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No - P 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 �1zSgged SAS or cesspool Static liquid level in the distribution box above outlet invert esspool due to an overloaded or clogged SAS or � — ququid depth is cesspool is less than 6"below invert or available volume is less than%day flow — _✓Required pumping more than 4 times�the last year NOT due to clogged or obstructed i e s .N o times pumped gg P P ( ) umber any portion of the SAS,cesspool or privy is below high ✓Any portion of cess ool or ri ° Water elevation. P P �'Y within 100 water supply. feet of a surface water supply or tributary to a surface _any portion of a cesspool or privy is within a Zone 1 of a public well. portion of a cesspool or privy is within 50 feet of a private water supply well. Y Portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water PP1Y well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and presence of ammonia the presen nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that en other failure criteria are triggered.'A copy of t}1e analysis must be attached to this form.1 - - (Yes/i�o) The system fails.I have determined that one or more of the as described a er ne w 15.303,therefore the system fails.The system should contve failure criteria act exist R r l„f Health to detele what will be necessary to correct the Y oa.,.„ failure. E. Large Systems: gpd-To be considered a Large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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 ma H of a public water supply well mapped If you have a.t*twarad"ya3"ao� u c5Ljoj3 in section E the system is considered a Yes n Section D above eat� or an wered the large Y em has failed. The wne owner operatorf any larrgge systemconsidered a significant threat under Section E or failed under Section D shall u a 15.304. ire system owner should contact the appropriate regional office of De a tem in accordance with 310 C111R Department. Firlo Q rncr r;n .nr�n.( 1S/7Ml1 4 ?age5of1i OFFICLAL LNSPECTION FORIM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 19 Owner• G Date of Inspection: Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes -o na 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? vHave / large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A Was the facility or dwelling inspected for signs of sewage back up? Was the site inspected for signs of break out? Were all system components,excluding the SAS,located on site? _✓ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition' " of the baffles or lees,material of construction,dimensions,depth o f liquid, / �P q d,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: Yes o Existing information_For example,a plan at the Board of Health. Determined in the field(if any of the failure criteria related to Part is unacceptable) [310 CIIlt 15.302(3)(b)J C is at issue approximation of distance Tirlo C Incronrinn �nrrr+ All C/ItIAn 5 Page o of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM NTS PART //SYSTEM INFORMATION Property Address: �co Owner: Date of Inspectio /- _ 0-46 54pli REs W CONDITIONS m�:�°TI.�, �� `umber of bedrooms(design): ber of bedrooms(actual),f,• DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): — Number of current residents: Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no);/ [if yes separate inspection required] Laundry system inspected(yes or no):lfl' Seasonal use: (yes or no):/T/rJ Water meter readings,if available(last.2 years usage(gpd)): SUMP Pump(yes or no): /I/b Last date of occupancy: C O'MMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): d Basis of design flow(sears/persons/sgf3,etc.). - Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use:_ OTHER(describe): Pumping Records GENERAL INFORMATION Source of information �/ / QQ 99 `w as system pumped as part of the inspection es or no ey,o/L If yes,volume pumped: eallons--How was quantity Reason for. q ty Pumped determined? pumping: TYP F 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) _Tight tank _Attach a copy of the DEP approval —Other(describe): :approximate age of all components,date instal if known) d urcc of information. 're:e sewage-e aaors dz-� v.,cred when arriving at the sire(yes or no):&5V Tirlo � l.eore,-rinr. �nrrr !./i S/7!1!�(� 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C (� SYSTEM INFORMATION(continued) Property Address: T Gle4 Owner: 4 Date of Inspection: / — —O .6 BUILDLtiG SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of;oints,venting,evidence of leakage,etc.): SEPTIC TAINK:_(I" ocaie on site plan) Depth below grade: Material of construction:��concrete metal fiberglass_polyethylene _other(explam) — If tank is metal list age:— Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) �. , � Dimensions: - X Sludge depth: Distance from top o sludge to bottom of outlet tee or baffle: 02.2 r� Scum thickness: . Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bop�g]�}of outlet tee r baffle: How were dimensions determined.No(e Comments(on pumping recommendations,inlet and outlet tee or baffle conditio structural integrity, as related to outlet invert evidence of leaks/pae/etc.): m' grity,liquid levels / G o v :7- 6�h��/CJ /✓� l' �N d r T'�0�. GREASE TRAPeL(locate on site plan) Depth below grade:— Material of construction: concrete metal fiberglass_polyethylene other (explain): — — — — Dimensions: Scum thickness: Distance from top of scum of top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on Pumping recommendations,inlet and outlet tee or baffle condition'structural integrity,as related to outlet invert,evidence of leakage,etc.): liquid levels Tfth S incr,� tGnn P-- Ail 7 I Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C �j SYSTEM INFORMATION(continued) Property Address ��/ �G'a' /"�Gt✓SLt �� ✓ f' ,y Owner: '5" Date of Inspection: TIGHT or HOLDEN G TANK:i(/ (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: ga dons Design Flow: _ gallons/day Alarm present(yes or no): Alarm level• Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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 or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: l / u 1141ai—f 4 Q Owner: cJ Gt�K Date of Inspection."' /— �— 0 J& SOII.ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number: leaching chambers,number.Ieaching galleries,number: pC leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool, number: innovativeialternadve system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): f oµ�t1 �f - 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:l!/ (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.): 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM LNFORTMATION(continued) Property Address: ��/ GlPc•T �lt � �� / Owner: Soy ! 1•� Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch 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. Ilk 14 a7 1� O tt All / d3- 39 ;7 —A/I cnnnn 10 . Page11of11 � •e OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property address v, ,¢ ©d,6 3� Owner' SR l✓! Date of Inspection' 0 SITE EXAM Slope Surface water Check cellar Shallow wells /O� 0 3 or ,I Estimated depth to ground water 3a'f feet ` A4o 3 0 Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design.plan reviewed: ✓ rved site(abutting property/observation hole within 150 feet of SAS) 70 F Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You m�t des a how you established the hi It ground water elevation: , CT/Oki► iry-le G 7'LArI loca,,v,,7 15 o,^? p liG-- " — v . ioP o�' Gad �1 y ±t 9 Tiil� � Fncr.�niinn �.�rrr. Ali Si7(1(1!1 11 FtHE To,,, Town of Barnstable 0 Department of Health, Safety, and Environmental Services w IARNSPABLE. MAS&;�9 ,0� Public Health Division A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health September 29, 2006 Diana L Saling 91 RTE 28 Apt. 60 West Yarmouth, MA. 02673 NOTICE TO ABATE VIOLATIONS OF THE TOWN OF BARNSTABLE CODE, 060-20 (I), The property owned by you located at-407Great Marsh Road Centerville, MA. was inspected on September 21, 2006. by Linda Edson from the Building Department responding to a possible illegal apartment complaint. The following violations of the Town of Barnstable On-Site Sewage Disposal Systems Ordinance, §360 was observed: 060-20 (I): Criteria for Determining System Repair or Replacement There were a total of five bedrooms observed in the dwelling. However, the existing septic system was permitted for 3 bedrooms with a design flow for four bedrooms.. You are ordered to remove one (1) bedroom from the dwelling by removing entrance doors, by removing the beds, and by opening a door-way entrance (by partially removing walls) to one room to a minimum of a five foot wide opening. The second option is to upgrade your septic system to accommodate a design flow for five bedrooms within sixty days of your receipt of this letter. 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. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF JE BOARD OF HEALTH S omas A. McKean Director of Public Health Commonwealth of Massachusetts Executive Office of Environmental Affairs Department of Environmental Prote ctiQ�n QOo� s���,� One Winter Street, Boston MA 02108 (617)292-5500 yo�ti 1 g ie ,TRUDY COxE ` Secretary Al ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 407 Great Marsh Road, Centerville, MA Name of Owner: James Callahan Address of Owner:280 Beal Road Date of Inspection: -January 4, 2000 Waltham, MA 02154 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, Osterville, MA 02655-0049 Map: 190 Telephone Number: 5( 08)862-9400 Parcel: 191 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: ✓ Passes Conditionally Passes Needs Further Eval do By the Local Approving Authority _ ails Inspector's Signature: Date: January 4, 2000 The System Inspector shall submi copy of this inspection report to the Approving Authority(Board of Health or DEP)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 of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. NOTES AND C01M viENTS revised 9/2/98 Page 1of11 Primed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA ' Owner: James Callahan Date of Inspection: January 4, 2000 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: ✓ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 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. Indicate yes, no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying 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 Health) ' 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 revised 9 2 98 Page SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA Owner: James Callahan :? Date of Inspection: January 4, 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. I 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 AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(W and the SAS is within 100 feet to a surface water supply or _,tributary to a surface.water.supply.. , r The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER revised 9/2/98 Page 3of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 407 Great Marsh Rand, Centerville,MA Owner: James Callahan Date of Inspection: January 4, 2000 D. SYSTEM FAILS: You must indicate either"Yes" or"No" as to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. Static liquid level in the distribution box-above outlet invert due town overloaded or clogged SAS or cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is'witlun a Zone 1 of a public well: Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for- coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone II of a public water supply well The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4ofII SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 407 Great Marsh Road, Centerville, MA Owner: James Callahan Date of Inspection: January 4, 2000 , •n Check if the following have been done: -You must indicate either"Yes"or"No".as to.each of the following:. Yes No ✓ _ Pumping information was provided by the owner,occupant,or Board of Health. ✓* None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. (*House was vacant.) ✓ As built plans haye.been obtained-and examined., Note if they are not available with N/A,, �. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ _ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) (15.302(3)(b)]• ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. �. • l... -_ •t. .:1i .. max.}1.:l .�5,: 3�.t.._ • J .. .. :5. • .. ._. - . .. .... - . . I • '.3 ... ..r iw � .. revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 407 Great Marsh Road, Centerville, MA Owner: James Callahan Date of Inspection: January 4, 2000 t- FLOW CONDITIONS RESIDENTIAL: Design flow: 110 g.p.d./bedroom. Number of bedrooms(design): n/a Number of bedrooms(actual): 3 Total DESIGN flow n/a Number of current residents: 0 Garbage grinder(yes or no): No Laundry(separate system)(yes or no): No; If yes, separate inspection required Laundry system inspected(yes or no): No Seasonal use(yes or no): No Water meter readings, if available(last two year's usage(gpd): 1999-16,000 gals.: 1998-9,000 gals. Sump Pump(yes or no): No Last date of occupancy: Unknown COMMERCIAL/INDUSTRIAL: Type of establishment: Design flow: end(Based on 15.203) Basis of design flow Grease trap present: (yes or no) Industrial Waste Holding Tank present: (yes or no) Non-sanitary waste 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: Pumped on June 1. 1998-per Treatment Plant. System pumped as part of inspection(yes or no): No If yes, volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval -Other .'APPROXIMATE AGE of all components;daie lnstalied(if known)and source of information: June 1974-ner as built card. Sewage.odors detected when arriving at the site: (yes or-no) No _.... revised 9/2/95 Page6ofll SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA ;:r Owner: James Callahan ;.- Date of Inspection: January 4, 2000 BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron 40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 6" Material of construction: ✓concrete _metal _Fiberglass _Polyethylene other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(Yes/No) Dimensions: _ 1000 Qal. Sludge depth: -- Distance from top of sludge to bottom of outlet tee or baffle: 32" Scum thickness: -- Distance from top of scum to top of outlef 6i or baffler- 12" Distance from bottom of scum to bottom of outlet tee or baffle: 10" How dimensions were determined: Measuring stick 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.) The baffles were present. No scum or solids were present, only liquid. There were no signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: 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: Comments: _.. .... _ . (recommendation for pumping,condition of inlet and outlet_teesaor baffles,depth of liquid level in relation to-outlet invert,.structural integrity, _._ evidence of leakage,etc.) _ revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA ^•; Owner: James Callahan • Date of Inspection: January 4, 2000 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,,or 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/day _ Alarm present. Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) . PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA Owner: James Callahan L Date of Inspection: January 4, 2000 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,if possible;excavation not required, location may be approximated by non-intrusive methods] If not located,explain: Type: leaching pits, number: 1-6'x 6' leaching chambers,number: leaching galleries,number: leaching trenches,number, length: _ leaching fields, number,dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) The pit was dry and there were no signs of failure. The bottom to grade was 8'. CESSPOOLS: None (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(cesspool must be pumped as part of inspection). Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.) PRIVY: None (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.) revised 9/2/98 Page 9of11 f SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C, SYSTEM INFORMATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA +. , Owner: James Callahan , u..... Date of Inspection: January 4, 2000 r. ; Map: 190 Parcel: 191 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 3ACk i I «k I a Ai- I a, AD,- revised 9/2/98 Page 10of11 A SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 407 Great Marsh Road, Centerville, MA Owner: James Callahan z. Date of Inspection: January 4, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater 30+/- Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record ✓ Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. (Must be completed) Using the Barnstable topographic and water contours maps, the maps were showing approximately 30'to groundwater at this site. Hand augered down in the middle of the pit to 12' below grade, and no water was observed. The high groundwater adjustment for this site(MI W 29, Zone D, 11199)was 6.3'. Taus report has been prepared and the system inspected and passed as of the date of inspection. Tlus report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. revised 9/2/98 Nge11of11 TOWN OF BARNSTABLE LOCATION 4-10-1 6 e+41 14ArS� R d SEWAGE # a VII--LAGE Ce�►Terv��� II'' ASSESSOR'S.MAP & LOT INSTALLER'S NAME&PHONE NO. de.^e^4 L4MT t SEPTIC TANK CAPACITY /QaU LEACHING FACIL=: (type) P tT (size) 6 X(O NO.OF BEDROOMS BUILDER OR OWNER— A+M2S 0-41✓4,r\ PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: $ �,L JV%S ton 1 N 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 Fumished by 3� i j+ a,_ a�• O a f33• 39 3 ' No.........1 f :i F��......1..................... THE COMMONWEALTH OF MASSACHUSETTS BOARD PF HEALTH _..... OF...... ... ...... __... -------------------- Appliratinn -for Biipwial Workli Ptuitrurtion Vrrtuft Application is hereby made for a Permit to Construct ( <or Repair ( ) an Individual ewag sposal Syst at �- ocatio dress t- 1r); Lot No. wner ddress W G_� •---- -----------------------------•--•------Installer ddress _ q. feet Type of Buildi. Size Lot....l_��_�_w/.�S Dwelling—No. of Bedrooms__________________________________________Expansion Attic ( ) Garlfage Grinder ( ) Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Otlier fixtures ----__ ______---------------------------------------------------------------------------------------- W Flow. ...................... ..... ....... 11ons per person per day. Total daily flow___-___ ----__.._-__..__.._..____.------------------------ Design gallons. P P P Y Y g� WSeptic Tank Liquid capacity Ions Length................ Width---------------- Diameter -------------- Depth---- x Disposal Trench—N9..................... Wi,th._._._.... _.._____ en th____ _ __ .-•_ .. tal le ling area------------._.-----sq. ft. Seepage Pit No........ Diameter _ lie ow in .............. ..t`�aI a liir area------------------sq. ft. z Other Distribution box ( ) Dosing tank ( ) ~" Percolation Test Results Performed b .___.._. Date____________________________________ a --- a Test Pit No. I----------------minutes per inch Depth of Test Pit____________________ Depth to ground water_.__-_____.._._._._. fXq Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water-----------.------------ ----------------------___________ �_`-_ __ - __ .. .. --------------- _ _ _ Description of Soil --------- - / \ ......-•.............................•__-_-----------------------__----,yl!?p I _-- ��f .. .... __-••_ _•- __. ..____•_•_•_• _•_S•__`',/i •__�%" VNature of Repairs or Alterations—Answer when applicable._._..-•__________________________________________________-----------------_____--------------- --------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ...... Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI 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 Itboard of health. gned 1 � ���--- ----• ------ 4te t ••-•---•-- Application Approved By........ ' = ------ l- Application Disapproved for the following reasons:.................---------------- -------------•---------•----••-••---------- --------------------------------------------------------------•--•--•.................... Date PermitNo......................................................... Issued........................................................ Date i No.. r Fi a....... ................ THE COMMONWEALTH OF MASSACHUSETTS BOA RD ?. LHI�.LTH .. .......OF....::. ............ ,t -Appliratiun -for Di-gposal Wo4�or ttstrurtion Vrrntit Application is hereby-made for a Permit to Construct ( Repair ( ) an Individual wag ; posal ..... ........4 ocatio dress Lot No. f �, -___ _ . wner ddress W w.. r` ........................�� Installer t Address ,y; UType of Buildi Size Lot....1_J�r_1___G.�Sq. feet .—i Dwelling No. of Bedrooms_______________ ___________________...____Expansion Attic _( ) Garbage Grinder ( ) aOther—Type of Building ____________________________ No. of.per sons---------------------------- Showers ( . ). - Cafeteria Q Other fixtures ----- - ----------------------------- --------- -----•-------- - ----- ,two W Design Flow. ............:........`- lions per person per day. Total daily flow_...._. *..'�._ .....................gallons. ~ W Septic Tccnk�Liquid capacity __:'__ allons Length________________ Width..____.._ __ . Diameter -_. ._._.____ Deptlr .....___. . Disposal Trench N Wid h.:: nth..__ _ tar lea 'ing area.____.`._..- _._sq. ft. x �} Seepage Pit No._=__:_l_-_-_ �. 'Diameter_ __ e ow :,._ al. e iit area_________________sc tt. Z Other Distribution box ( _ ) Dosing tank ( ) i),� / �. a Percolation Test Results Performed bY---=------------------------------------------------------------------ ---- Date--------...-------------------------- .5 Test Pit No. 1----------_----minutes per inch Depth of Test Pit.*................... Depth to-ground water_..-____--__-__---_.._. Test Pit No. 2.____q____:....:minutes per inch' Depth of Test Pi .................... Depth to ground water......------------------ -- -. --- ------- - y D 1 Description of Soil--------=----------------------------- J x` - U:. 4�� UNature of Repairs or Alterations—Answer when applicable ..........._------------------------------------------- ------------- ___ . ---------------------------------- Agreement: The..undersigned agrees to install the afore'described Individual Sewage Disposal System in accordance with the provisions of Article XI-of the State Sanitary'Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has beef .pis by.t board of earth. ned r / at,, t Application- BY •. --- -- . --- - � l .. �' sis ate Application Disapproved for t/t.e following reasons: A", ---------------------------------------------- .............................................:.. ---------------_.................. ._._................--•.____----•--_-__•__-_-__-•-----_-__-____-•"-_-------_-_-___-_____-___-_------_______-----•.--.-- i # Date ­.Permit'No _�.__...__.. ' Issued Date 4e, zEi CONI,,MONWEALTH OF MASSACHIJ'SETTS BOARD OF ALTH I. rtifiratle jaf Tilutpliartr TH S TO CERTIF at the Individual Sewage Disposal System constructed ( or Re ai _d ( ) .; by = --. . • ,» Installe h as been ii stalled in accordance with the provisions of Article XI o The State nitar C'od es h p y e s d e d the application for Disposal Works Construction Permit No__________________ dated...____ THE ISSUANCE OF THIS CERTIFICATE SHALL. NOT BE CONSTRUED AS A G NTEE THAT THE SYSTEM WILL FUNCTION-'SATISFACTORY. /7 y -•-------------------- Inspector-- ...-•-•••------ .................................................. j 4` 7--A i • ' ` a THE COMMONWEALTH OF MASSACHUSETTS BOARD OF4 HEALTH d O.Fi�✓ ,N0......� FEE__. _. r BipVa6a orkf an rtion Vrrmit Permission iPoWr granted ' - ---------- -- ---- ----- .......... --------•-------------------•---- to Cons tr �`( R'epa' ) an rlu wage spo=1 System i at No = .-- ---• ------------ -- Street /'y /f� as shown°:on the application for Disposal Works Construction Pe !�--/ ___. ........... e _ . - DATE_............. .................. --- -- _ - - ss B rdf-Ilea �:.firr.. �rey .M FORM 1255 HOBBS .& WARREN. IIJC.'. PUBLISHERS t./` .✓ C +: S • tESt PK$, P�esitG.. � '��s-c'. 'moo-•R {` �000 C�pA...sgpm4 TPA11�.. fi 119 � 30 t� �� 10 �• r Cp lcv� C� •Co��� { 25t� y tin.©o{ f: LEGEND o N EXISTING CONTOUR x 100.98 EXISTING SPOT GRADE a w —W EXISTING WATER SERVICE Y —6H.-W— EXISTING OVERHEAD WIRES TEST PIT J = BENCHMARK o GolAeto�L" Woodvale L a a C S o � _c Gorletoo 'Z. c \ O O6 vl F m Great Marsh Rd N m � o LOCUS J LOCUS MAP NOT TO SCALE 99.62 99.72CBCIh 100J3 �! 0,13 � ® .91 SPI�6E 0,00 100.02 Lu o�F o O 100.37 / 4p ( LAMP 4 S9, F'i'T • 19.76)100.62 °} 101.31\ aQ . ,. 10L43 "DRIVEWAY--'- 100.34 c x 7.69 ;�-... � ;PAVED DR/VEWAY:Y;.. EXISTING HOUSE 407 ET..: 100.98 T.0.F.=101.57E w DECK 100,77 - o - _ x N N.100.25 0' ' 1.03 x BM O �0 100.89 100.92 z BENCHMARK LAMP POST FOOTING + 100.76 EL.=100.89 100,12 EXISTING SEP77C TANK _ ::,' f 0 >(TO REMA IN) TOP OF TANK, EL.=100.05E TP 2 INV.(OUT)=99.70E EXIS77NG LEACH PI T -TP-1`.7- TO BE PUMPED, FILLED 8• WITH SAND & ABANDONED 'L 100.59 100.46 1 °�, s_ LOT 5 s "o. b10,063±S.F. ������ OF MAs�gcti x 1 .74 o PETER T. o McENTEE CIVIL No. 35109 fGIS1E�``� F I Ic PARCEL ID: 190-191 PROPOSED SEPTIC SYSTEM UPGRADE PLAN 407 GREAT MARSH ROAD, CENTERVILLE, MA Prepared for: CARIBBEAN REALTY, INC., 7 Elm Road, Mashpee, MA 02649 OWNER OF RECORD Engineering by: SCALE DRAWN JOB. NO. CARIBBEAN REALTY, INC. Engineering Works, Inc. 1"=20- P.T.M. 121-19 7 ELM ROAD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET No. MASHPEE, MA 02649 (508) 477-5313 2/23/19 P.T.M. 1 Of 2 r NOTE: TO PREVENT BREAKOUT, FINAL GRADE SHALL NOT BE AT, OR BELOW, EL.=99.0 SEPTIC TANK PROPOSED D-BOX FOR A DISTANCE OF 15' FROM THE EDGE OF THE PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & WATERTIGHT PROPOSED S.A.S. OUTLET AND SET TO 6" OF FINISH GRADE COVER SET TO 6" OF GRADE INSTALL RISER & COVER OVER ONE CHAMBER AND T.O.F.=101.57t SET TO 3" OF F.G. TO SERVE AS INSPECTION PORT F.G. EL.=100.7t F.G. EL.=100.6t F.G. EL.=100.6t F.G. EL.=100.5t ff MAINTAIN 2% SLOPE OVER S.A.S. NWROORM Moo ' L = 12' L = 5' S=1% (MIN.) ® S=1% (MIN.) 2• LAYER OF 1 8 TO 1 4"SCH40 PVC 4"SCH40 PVC / • /2• 6"+ DOUBLE WASHED STONE �p"I " _a $ as (OR APPROVED FILTER FABRIC) LL-iia" s• 2' EFF. 000000a EXISTING 48• LIQUIDD DEPTH aaaaaaR -3/4• TO 1-1/2• DOUBLE wA�1Eo STONE LEVEL ADD 4' 4.8' 4' _ GAS BAFFLE INV.=98.77 PROPOSED INV.=98.60 INV.=99.70t D-BOX EFFECTIVE WIDTH = 12.8' EXISTING INV.=98.50 r EXISTING SEPTIC TANK 2-500 GALLON LEACHING CHAMBERS SURROUNDED WITH STONE AS SHOWN NOTES: H-10 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=99.3t INVERTS, PRIOR TO INSTALLATION. BREAKOUT ELEV.=99.00 INV. ELEV.=98.50 ____ 2)'D-BOX SHALL BE SET LEVEL AND TRUE TO aaaa_ aaaaaaaaaaa GRADE ON A MECHANICALLY COMPACTED SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN BOTTOM ELEV.=96.50 310 CMR 15'221(2). 4' 2 x 8.5' = 17.0' 4' PERVIOUS MATERIAL 3) INSTALL INLET & OUTLET TEES AS REQUIRED. 4' OF NATURALLY OCCURRING EFFECTIVE LENGTH = 25.1 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. NO G.W., EL=90.5 - LEACHING SYSTEM SECTION SEPTIC SYSTEM PROFILE N.T.S. GENERAL NOTES: - 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS /EXISTING OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE HOUSE 407 LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR T.O.F.=101.57f TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. DECK _ . .. _ 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF N t0 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. -1 38.8• 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. d 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS �� A 114, ' AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY cL THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO, BEGINNING 0 N CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SEPTIC LAYOUT IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). -� 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE INSPECTED BY DESIGN ENGINEER PRIOR TO BACKFILL. SOIL LOG 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND NOT CONSIDERED TO BE A PROPERTY LINE SURVEY. DATE: FEBRUARY 11, 2019 (REF#15,898) 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC SOIL EVALUATOR: PETER McENTEE PE(SE#1542) SYSTEM COMPONENTS NOT SHOWN ON THE PLAN WITNESS: DONALD DESMARAIS R.S.HEALTH AGENT ELEV. T P- 1 DEPTH ELEv. T P-2 DEPTH 100.5 A 0 100.6 A 0" LOAMY SAND LOAMY SAND 10YR 4/2 10YR 4/2 DEIGN CRITERIA 100.0 BOAMY SAND 6 100.1 BOAMY SAND 6 ` 10YR 5/8 10YR 5/8 NUMBER OF BEDROOMS: 3 BEDROOMS 98.5 24" 98.5 25" C1 Ci PERC SOIL TEXTURAL CLASS: CLASS I M-C SAND M-C SAND 30"/48" 2.5Y 6/4 2.5Y 6/4 DESIGN PERCOLATION RATE: <2 MIN/IN 20% GRAVEL 20% GRAVEL DAILY FLOW: 330 G.P.D. 94.5 C2 72" 94.5 C2 73" DESIGN FLOW: 330 G.P.D. MED. SAND MED. SAND GARBAGE GRINDER: NO-not allowed with design 2.5Y 6/6 2.5Y 6/6 5% GRAVEL 5% GRAVEL LEACHING AREA REQUIRED: (330) = 445.9 S.F. 90.5 120" 90.6 120" .74 PERC RATE <2 MIN/IN. "C" HORIZON EXISTING SEPTIC TANK: 1000 GALLON CAPACITY NO GROUNDWATER ENCOUNTERED PROPOSED D-BOX: 1 INLET, 3 OUTLETS, H-10 RATED USE 2-500 GALLON LEACHING CHAMBERS IN SERIES PROPOSED SEPTIC SYSTEM UPGRADE PLAN SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 407 GREAT MARSH ROAD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: CARIBBEAN REALTY, INC., 7 Elm Road, Mashpee, MA 02649 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:.............................................................. 471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 121-19 DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 2/23/19 P.T.M. 2 Of 2