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Home My WebLink About1006 CRAIGVILLE BEACH ROAD - Health (2) 1006 Craigville Beach Rd Centerville P A = 226 00400H I i i � /te 1521/3 ORA 10% P2 11 d c i P Y i i k 1. K a a4P OOA Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 ' Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. City/Town State Zip Code Date of Inspection F 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 61* 15o13Co on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return Company Name key. 52 Rivers End Road r� Company Address Teaticket Ma. 02536 City/Town State Zip Code 508-280-3356 S13938 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 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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: This complex has 8 units and 15 bedrooms. The system has (2) 2000 gallon septic tanks, a 2500 gallon pump chamber with D-Box feeding a 48' x 48' leaching field. At the time of the inspection no visible failure criteria was found. 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 c Commonwealth of Massachusetts i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. Cityrrown 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. 1 ❑ 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 k, 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 cry Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is Centerville MA 02632 03/12/2021 required for every � page. Cityrrown 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 ❑ ® 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 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is Centerville MA 02632 03/12/2021 required for every 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. F 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. City/Town 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 c , Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. Cityfrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 15 Number of bedrooms (actual): 15 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 1650 GPD plus Description: Number of current residents: 0 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 town water 9 ( Y 9 (gpd))� Detail: In 2020 - 106,000 gallons were used and in 2019- 131,000 gallons were used. Sump pump? ❑ Yes ® No Last date of occupancy: occupied 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 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. CityrFown 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: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form IN Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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) P ❑ 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 i ❑ Tight tank. Attach a copy of the DEP approval. 4. i ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 11/7/2000 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 36"feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: town water feet Comments (on condition of joints, venting, evidence of leakage, etc.): Water was flushed and came freely. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"tee" Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) a 4 i If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Two 2000 gallon septic tanks Sludge depth: 2 34e i Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? sludge judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): I recommend the new owner put the septic tank on a maint. plan with a local septic pumping co. based on the future use of the home. At the time of inspection the liquid level was at working level and the tee's were in place. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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 c Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments /n 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 i page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) i Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 11 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.): At the time of the inspection the liquid level was at working level and there were no visible signs of leakage or solids carryover. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts M p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v � 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. City/Town 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.): I ran the pump and tested the alarm * 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: One 48'x 48' ❑ 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 - p Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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.): At the time of the inspection no visible failure criteria was found. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration I 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 A = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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 1" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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 a � r o I OS i fly t5insp.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 i Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 page. City/Town 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: 5 plus feet 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: I augered a hole at a lower elevation and shot it with a transit to show 4 plus feet of seperation. 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd Units 5 and 8 Property Address 1006 Craigville Beach Condos Owner Owner's Name information is required for every Centerville MA 02632 03/12/2021 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe p Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. Cityrrown State Zip Code Date of Inspection k�a Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, use only the tab Michael T Bisienere key to move your Name of Inspector cursor-do not Cape Septic Inspections use the return p—- p key. Company Name 624 Old Barnstable Road Company Company Address Mashpee Ma. 02649 toe City/Town State Zip Code 508-280-3356 S13938 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 01� 12-2-2018 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. P t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments .•, /% 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 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: This complex has 8 units and 15 bedrooms at the time of the inspection threre were no visible signs of past hydraulic 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.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 S ' Commonwealth of Massachusetts Title 5 Official Inspection Form I a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Crai ville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: 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 l, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. Cityrrown 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 ❑ ® 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 t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ............. ,V!% 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® 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. El ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public 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 El El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 r - Commonwealth of Massachusetts �- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma 02632 11-30-2018 page. City/Town 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 ' Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments N� 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is Centerville Ma. 02632 11-30-2018 required for every ' page. CitylTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: , Number of bedrooms (design): Number of bedrooms (actual): 15 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 0 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 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Fall 2018 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments A 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 'Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc 'rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 ' Commonwealth of Massachusetts ,p Title 5 Official Inspection Form 1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 11 � 1006 Craigville Beach Road Units 6 &7 V� Property Address Charles Hobe Owner Owner's Name information is a required for every Centerville Ma. 02632 11-30-2018 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 I ❑ 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: 2000 Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 36"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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 ' Commonwealth of Massachusetts Title 5 Official Inspection Form I o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 24"feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Two Standard 2000 gallon Dimensions: 2" ; Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 2" 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 12" Sludge Judge How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): _ The outlet tee was in place and the tank appeared structuraly sound. I would recommend the new owner put the septic tank on a maintenance plan with a local septic pumping co. based on the future use of the home. The local Health Dept. has a list of septic pumping co. R t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 ' Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. City/Town 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):P 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 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's,Name information is required for every Centerville Ma. 02632 11-30-2018 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): OilDepth 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.): At the time of the inspection there were no visible signs of leakage or signs of past hydraulic failure. 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 L ............. 0 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 page. City/Town 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* a 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: one 48' x 48' ❑ 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 i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ----------- 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 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.): At the time of the inspection there were no visible signs of past hydraulic failure. 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 Commonwealth of Massachusetts Title 5 Official Inspection Form tiu Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Road Units 6& 7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 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 ,- p �1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 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 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 �•G TOWN OF BARNSTABLE LOCATIONALA� �,k,� V SEWAGB# VILLAGB CGn{�RV:/lG ASSESSOR'S NAP A LOT ]INSTALLER'S DAME&PRONE NO. A & B CATTCU 77r+-�2�d SEPTIC TANK CAPACITY C-2) oIrmo LEACHING PACILIT�7i/:(typ(�e)(/6Ac f ,NO O BBDROOI[SC "'�" P UVATE WELL OR PUBLIC WATER • lUILDBR 013(4�,"-r.+� -.reR,em v,4# axo v i N DATE PERMIT ISSUED: D [PpD DATE COMPLIANCE ISSUED., //— 9—Ov VARIANCE GRANTED: Yes No -c O O 1l6_ i Q\ 4L Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Road Units 6 &7 Property Address Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 r page. City/Town 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: 5 plus � 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: pate ® 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: I augered a hole at a lower elevation and I shot it with a transit to show 4 plus feet of seperation. 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 1006 Craigville Beach Road Units 6 &7 Property Address • Charles Hobe Owner Owner's Name information is required for every Centerville Ma. 02632 11-30-2018 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 J t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 AIR .2---Z-, 00, — Commonwealth of Massachusetts / - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Robert Paolini use the return key. Name of Inspector Robert Paolini Septic Service ICI Company Name 17 Playground Lane Company Address Yarmouthport MA 02675 City/Town State Zip Code 508 362-3555 S 14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: 2 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3/15/14 Inspector's Signatur --- Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Tile 5 OfficiajInso rm:Subsurface Sewage Disposal System•Page 1 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑x I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below).- El The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ 0 Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ❑x Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection B. Certification (cunt.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 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. ❑ 0 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ 0 Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ 0 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ 0 The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No 0 ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? ❑ ❑x Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? 0 ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑x ❑ Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? 0 ❑ Were all system components, excluding the SAS, located on site? ❑x ❑ 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? 0 ❑ 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: ❑ 0 Existing'information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 15 Number of bedrooms (actual): 15 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 1650 t5ins•W3 Tibe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 r I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: na Does residence have a garbage grinder? ❑ Yes ❑x No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑x Yes ❑ No Seasonal use? 0 Yes ❑ No Water meter readings, if available last 2 ears usage d na 9 ( Y 9 (gP ))� Detail Sump pump? ❑ Yes 0 No Last date of occupancy: 3/15/14 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes 0 No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: 0 Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑x Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed(if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron ❑x 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the building vents. Septic Tank(locate on site plan): Depth below grade: 2' feet Material of construction: 0 concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 2/2000gl Sludge depth: 4" 5" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 39" 40" Scum thickness 3" 4" Distance from top of scum to top of outlet tee or baffle 6" 5" Distance from bottom of scum to bottom of outlet tee or baffle 13" 12" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump tank every 2 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments e'a 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert No Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Box is Ievel.Box has seven outlet lateral. No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ❑x Yes ❑ No* Alarms in working order: El Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): 2500 gl Pump chamber appears structurally sound. Pumps,floats and alarm in proper working order. * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ teaching galleries number: ❑ leaching trenches number, length: ❑x leaching fields number, dimensions: 48'x48'x6" ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy soil.Leaching field was dry at time of inspection. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 r i Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Properly Address Coral Village Assoc. Owner Owner's Name information is Centerville MA 02632 3/15/14 required for every --- -- page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately i o ~9� o c . �- Cr �+ o (Sins•3/13 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 1s of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑x Check Slope n Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 5' 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 ( 9 ) Checked with local Board of Health-explain: As-Built ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:USGS observation well data.USED:Technical bulletin 92-0001 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1006 Craigville Beach Rd. Property Address Coral Village Assoc. Owner Owner's Name information is required for every Centerville MA 02632 3/15/14 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist 0 Inspection Summary: A, B, C, D, or E checked Z Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑x System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 .. a 1r -A _� .0o lf Cct� N1AR 1 0 2005 n. hIT .6. I r mow.. .. . row, ..t Ht ,:A'STAtLE TH DFPT. DATE-1 �"�j . ,5 Rd. unit 8 PROPERTY ADDRESS Cent. oz 3 ePtic system at the address above was On the above date, th" inspected. This system consists of the following,.. 1.,2-2000 ga eion Septic 7ank,3., 2., 1-2500 gaiion pump Chamge2., 3.4-Di,3t2,iaut.ion gox.� 4., 1-Lech.ing Tieid 48'x48' x6" conditions: Based on inspection, I certify the following 5.-7h.i,3 .iz a 7itie Five Septic Syhtem.' 2eent time. 6.,7he 3en.t �6 ;ic Y,6tem .iz .in paoPe2 wo2king olden at the /� ,y . SIGNATURE Name: Robert A. Paoilni Company: J°seph P. Macomber &Son Inc. Address: P. O. Box 66• Centerville Mass 02632 Phone: 508-775.3338 or 508-775-6412 LU -.T Ca JOSEPH P. MACCMBER & SOON,: NCW Tanks-Cesspools•4eachfi •pumped .&•.Installed ' Town Sewer'Connections P.O. Box 66 Centerville, MA.O2632"0066 :� 776430 775.6412' ' COMMONWEALTH OF MASSACHUSETTS EXECUTIVE-OPPICF OF ENVIRMMSN'TAL AFFAIRS r^. ] EPA iTMENT OF N�jio��TAL�R�T CTION r r 'TITLE 5 OFFICIAL INSPECTIOl�I CORM^ T DISPOSAL SYSTEM FORM ��TS SUB-SURFACE SEWAGE DISPOSAL CERTIFICATION Property Address:1.006 Caai yvi e ez Beach Rd.,urz.i.t 8 Cente2vTUe (7a Owder's Name: 7heodofze I(uao� Ownef's Address: S a e Date of Inspection: Nance of Inspector: (please print) 8°i e nt ?a o.e j n.i Company Name: �' M.,w n m Q O h. po. BiAn l• c. Mailing•AddVess: _ �n e2v.� e, abb.•0263Z • Telephone Number, 5 0.8 CERTIFICATION STATEMENT . ion 1 certify that I have personally inspected the sewage disposal systeitt at this addresson was erfornaed based on reported oy ed below is true;accurate and complete as of the time of the inspection.'>'lie tnspe p training and experience in-the proper fain st.e on.IS 340 of•Tiitla 5(3l CMR•I5:�1and maintenance of on-'�ite sewage 00)alTheeessystem: a DEP approved system inspector pursuant to sect xx Passes Conditionally Passes Needs Further Evaluation.by the Local Approving,Authority Fails; • • Date: - � ector's Si �re: Insp �ata inspector shall submit a copy of this inspection•report'to the.Approving or has deli(Board of Health or The system asp ection.If the systelti is.a.¢hazed sY or has a design flow of 10,000 DEP)within 30 days of completing this in. office of the gp I or greater, the inspector and the system ewn a�ad c piubmit ts senptorth b yegPf pp 6je and the app©vmg DEP.The.original should be sent to-the syst • authority. Comments Notes and. . . .. tions of use at-th9t **** his're ort only describes conditions at tho time of inspecti0r and he f tounder re underithe same or different '� P ^ time.This inspection does not address how the system will perform in u conditions of use. ._ .I.r^^AA naaa 1 Page 2 of 11 OFFICIAL INSPECTION FOIZI�?I-NOT.-FORVOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM a PART A CERTIFICATION (continued) Property Address:9006 C2aigvieee L9P_ach Rd.'uni;t 8 Cen.tenv7��e (�a. Owner: 7heor�o2e Kyao� Date of-inspection: Inspection Snm`mary: Check"A;ZI C,D or.EJ ALW YS`complete-alI of.Section.:D A. System Passes: n o 1.have not found any information which indicates 4hat 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: n° One or more system components.as described in the"Conditione&Pass"tsectionneed to be replaced.or 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,N,ND)in the for the following statements.If"not determined"please explain.. n o. The septic tank is metal.and.over 20 years old*or the septic tank(whethermetal.or.not)is structurally unsound,exhibits substantial infiltration or exfiltration.or tm*failure:isimminent:system will pass inspection if the existing tank is replaeed.with'a complying septic tarilc:as appr©ved by theZoard 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: no • 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 6placed ND explain: n o 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): W. broken pipe(s)are replaced obstruction is removed ND explain: '2 Page 3 of 11 OPF CIAL MFECTION FORM-NOT,'OR V'OL•NAKY T ON RM-SMENTS SUBS'�ACE SEWAGE WSROSAL SYSTEM . PART°A.. . C 'RT.MCA'ION'(6ontinued)' 1006 CaaigVijj?• Beach I?d. unit 8 Property Address: 1 -ir OOn G Owner:. 7h-odoae7 77 2% Hate of Inspection: C. Further Evaluation-is.Required by the Board of Health: which f 1her..evaluation•by.the Board:offHealth:in order,to4etertnine if-the system no Conditions.exist require Ts failing to protect public health,safety or the environment. „fMR 153030)(b) 1. System will ppass unless Board o.Hesiitb i 6rrai protect public health,t' safety•no•the viroame that system is-not funetionfing iD.a m no Cesspool or privy is-within 50 feet of asurface water vegetated wetland or a salt marsh. 2 oo Cesspool or privy is within 50.feet of•a bordering ve8 : . 2. S stem will fall unless the Board•of Health(and public Water Supplier;- u plandif any)environment: the y, t5' system is functioning in a matfner.that protects the. health, no The system has aseptic tank and soil absorption system•(SA•S).:and the$AS is within l 00 feet of a surface water supply or-tributary to a surface water supply. n O The system-has•a.septic tank and SAS and the:SAS is�w•ithin a Zone 1 of a public water-supply. well. n o The system has"a septic tank and.SAS and-the-SAS is within-.50 feet of a private water. supply \ n o The system has a septic tank and SAS and the'SAS is less than 100 feet.but 50 feet or.-snore from a .Method used to determine distance, private water supply well** r coliforin **This system passes if the well waters indicates s that t the free from-pollution ut on fromhat facility a1d bacteria and volatile organic compounds indicates that the ,. rovided that no other the presence of ammonia d�A copy nitratehe analysis nitrogeil is equal to or.less than 5 m must be to-Ibis i forth p failure.criteria are trigger PY Y 3. Other: Page 4 of 11 OFFICILAL-INSPECTION FORM NOT FOR VOLUN. ARY ASSESSMENTS SUBSURFACE.SEWAGE DISPOSAL SYSTEM.INSPECTION:FORM PART A . CERTIFICATION(continued) Property Address:1006 C2aigvi eif. Beach Rd. unit 8 Cen.teavi eie, Na., Owner: Theodo2e KLjao4 . Date of lnspection:i� D. System Failure Criteria applicable to all systems:. You must indicate."yes"-or"no"to.eacb ofthe:following,for all:inspections: Yes No x Back-up of sew8ge•:into-fat �lity.:or system''component due to overloailed.oi clogged SAS..:or.cesspool x ' Discharge:or ponding of effluent to the,surface bi'ther.ground or...surfacematers due to enoverloaded or clogged SAS er cesspool ' x Static liquid level in the distribution box above.outlet invert due to an overloaded or clogged SAS or cesspool _ x Liquid depth is cesspool is less than.6"below invert or.available is less than volume flow _ x Required pumping more,than-4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ' x Any portion ofthe SAS;cesspool or privy is below High ground water elevation. —_ x Ariy.portion of cesspool or privy is within 100 feet of a surface water supply.or tribptary to a surface water supply. x Any portion.:of a cesspool r or.privy is within,a:Zone!1.•of&-public.-well.. x Any portion of a cesspool or privy is within.50 feet of a private water supply well. x Any portion of a•cesspool or-privy is less-than 100 feet but-greater.than 5Q.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 coliform bacteria and volatile organic:compounds indicates:that the well is.free from pollutlogSrony bat.facility 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-niust be attached.to this€orb.] no •(Yes/Nio).The system fa_ils..I•have determined that.one or.more.of:the:above.failurc:,criteria exist as described in 310 CMR 15.303,there€ore the.systerrl•fails.The-system owner.should contact the Board of Health-to determine what will be-necessary to correct the failure. E. Large Systems: To be considered a large system the:system must.serve.a-.€aeility with a design flow of 10;00.0 gpd to 15,000. gpd• 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) a- yes no — x the-system is within 400 feet of a surface drinking-water supply — x the system.is within 206 feet of a tributary to g water supply a surface drinking x. the:system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped 77 Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner-or operator of any large system considered a significant threat under Section E or failed under Section D*shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 4 Page 5of11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARYT ONI ASSESSMENTS g1tSURFACESEWAGE DISPP R �YS CHECKLIST Property Address: u ch Rd.,.un j.t 8 en eay.c e Na., Owner:7 he o d o 2 a Date of Inspection: _. L � p 5 " Check if the followin have been done.You Must indicate` s"or"no"as to each.of the oilow.in Yes No ccupant,or Bo " x _ Pumping information was pro Vided'by the owner,oazd of Health x Were any of the system components pumped out in the previous two weeks? x _ Has the system received normal flows in the previous two week period? _ x Have large volumes of water been introduced to the system recently or as part of the inspection? x Were as built plans of the system'obtained and examined? (If they were not available hote as N/A) x _ Was the facility or dwelling inspected for signs of sewage back up? x _ Was the site inspected for signs of break out? x . _ Were all system components,excluding the SAS,located on site _ Were the septic tank manholes uncovered,opened,and the interior de of the tank inspected for the of sludge and.depth of scum condition x depth of liquid,, of the baffles or tees,material of construction,dimensions, ep. 9 P x _ Was.the facility owner(and occupants if 8iffdrent frorn 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 determttYed based on: Yes no plan at the Board of Health. " x Existing information:For example,.a p x 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(3)(b)] v. . 5 Page 6 of l l OFFICIAL 1-NSPEC.Ti- N.FOR,M'-NOT FOR VOLUNT-ARY ASSESSMENTS Si1RSUPFACE-SUWAGE DISAOSA-L:SYSTtM INSPECTION:FORM PART.0 SYSTEM.INFORMATION Property Address: 1006 C2aiavit e 43each 12d., uri ct 8 Owner: 7h Date of Inspection: FLOW CONDITIONS RESIDENTIAL Number of bedroottts(desjgn):.:1 5. : ;Number of bedrooms.{actual): 3 DESIGN.flow based on 310 CWt 15.203(for a ample: l 10 gpd z#ofbedrooms): 5 x /O s 6.5 Q g/z Number of current residents:u n k n o w n Does-residence have a garbage grinder(yes br nq)n n Is laundry on a separate sewage.system,,(yes or.no)t o Cif y..es separate inspection required] Laundry system inspected(yes or no): tLz-z Seasonal use:(yes or no)::.1./ Water'meter readings,if available(last 2 years usage(gpd)):2 0 0 3 - 1 A n n n n-4 3 8.1 3 5 gl2 d Sump pump(yes or no): n o 2 0 0 4:4 7 7, 0 0 0 /3 0 6.18 4 gl2 d Last date of occupancy: unknown Bzoken wate2 zenv�ice ;an 2004 COMMERCIA.hUSTRIAL Type of estatk,' igilt: nu Design flow.(" on 310 CNIR 15.203):. na gpd Basis.of&sigo,fjow(seats/persons/sgft,etc.):, na Grease trap present(yes or no):a 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: na Last date of occupancy/use: . na _ OTHER(describe):. GENERAL INFQRMATION Pumping Records Source of information: a•'! N a c o m g e 2&S o n Was system pumped as part of the inspection(yes or no):net If yes,volume pumped: 2 0 0 0 gallons--How was quantity pumped detetrnined? m e a h u a e d Reason for.p..umping: ma�.caf-a.ince - TYPE OF SYSTEM n Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool _Privyv x 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 installed(if known)and source of information: �- item d 2000 Were sewage odors detected when arriving at the site(yes or no): n o 6 _ Page 7 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 7006 CZa Beach 12d.,unit 8 Owner:7heodo,ze Ky2o.s Date of Inspection: 2/.71/Q . BUILDING SEWER(locate on site plan) Depth below grade: 14" Materials of construction:_cast iron 40 PVC xx other(explain): Distance from private water supply well or suction line: 10' f Comments(on condition of joints,venting,evidence of leakage,etc.): c o .Qeaka e.'S .stem vented thzough house vent�.� I SEPTIC TANK: y e Ilocate on site plan) Depth below grade: 16" Material of construction: x x concrete other(explain) metal fiberglass_polyethylene _ — If tank is metal list age:n o Is age confirmed by a Certificate of Compliance(yes or no):—(attach a co of certificate) copy Dimensions: 1 Z'.eong/6 ' 6"W.ide/5 ' 8"h.igh Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or n_ baffle:n o 1 a d ye Scum thickness: no P Distance from top of scum to top of outlet tee or baffle:n o .6 c u m Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined; m Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural inte as related to outlet invert,evidence of leakage,etc.): lrity,liquid levels �• l um 12 tank eve2 2 an ou ea2z., 7ank a ea2.s �t2uctuaaQQy wound, Inlet d t het tees awe in ace.,No ev idence o Peakage., GREASE TRAP;a o (locate on site plan) Depth below grade: - na Material of construction:_concrete_metal—fiberglass_polyethylene__o (explain): n a ther Dimensions: n.n Scum thickness: na Distance from t0i of scum to top of outlet tee or baffle: n a v Distance from bottom of scum to bottom of outlet tee or-baffle: n a Date of last pumping: na Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural as related to outlet invert,evidence of leakage,etc.): integrity,liquid levels --------------- Titlo i Tner�nrtinn T7nrm�ii tionnn 7 Page 8 of 1 I OF-PICIAL IN-S-PECTION FORM—.NOT FOR VOLUNTARY ASSESSMENTS 5;: ]�-S-WXF:ACE S—EWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:1006 C2a.iqv.ii ee Beach Rd., ua i.t 8 ;nfon» Dho..i l�In_ Date of 1us.pection: r TIGHT or HOLDING TANK: no(tank must be pumped at time of inspection)(locate on site plan) Depth below.grade: na Material of construction: concrete—metal fiberglass T,polyethylene other(explain): - Dimensions: na Capacity: na gallons Design Flow: nu gallons/day Alarm present(yes or no): na Alarm level:_ Alarm In working.order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc,): Liam 2 ho.gd.ina .tankz• no.t 122e en.t.) - ened locate on site Ian) e� present must be o P DISTRIBUTION BOX: y (if pr.s p )( Depth of liquid level above outlet invert:no Comments(note if box is level and distribution.to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box, etc,): _ Box ha,6 .two -eateaa.Pz ateauai .2eveL No evidence o-1 -60-e-ids ca22yove2 T No evidence—o.4 .P akaae into 02 out PUMP CHAMBER: yeh (locate on site.plan) Pumps in working order(yes or.no):qg _ Alarms in working order(yes or no)yeZ CommPnts(note condition of pump chamber,condition of pumps and appurtenances,etc.): Q aze - woltkinclao e2� um 81 Page 9 of 1 I OFFICIAL INSPECTION FORM—NOT-FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 1006 C2a rev i P Pp Reach Rd..l unit 8 Owner:. 7heodo,ap Kun_ Date of Inspection:_:._ CU 7 SOIL ABSORPTION SYSTEM(SAS): t. eh(locate on site plan,excavation not required) If SAS not located explain why: Located see page 10 Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number, length: _u a leaching fields,number,dimensions: overflow cesspool,number: innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): �. . • hr QNo Ai nS n4y / r Vege t ion o,9nori1?,c nn1?mri0 , CESSPOOLS: n o (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration:' na Depth—top of liquid to inlet invert: na Depth of solids layer: na Depth of scum layer: na Dimensions of cesspool: na Materials of construction: na Indication of groundwater.inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level otponding,condition of vegetation,etc.): Ce,6,3/200iZ not /22e,6ent., PRIVY: n° (locate on site plan) Materials of construction: na Dimensions: na Depth of solids: na Comments(note condition of soil,signs of hydraulic failure,level ofponding,condition of vegetation,etc.): 2•Cyy not /22e•eent.l 9 e Page 9 of 11 OFFICIAL INSPECTION FORM—'NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INNSPECTION FORM PART C SYSTEM INFORMATION(continued). Property Address: 1006 Caa iavI fP_e [3each Rd.i unit 8 ' ( vn,tvnui�Pvi l�n �. Owner:. ZA2_Q Lo4 o Zun n.S Date of Inspection: 211 SOIL ABSORPTION SYSTEM(SAS):_e h(locate on site plan,excavation"npt required) If SAS not located explain why: Located see a e 10 Type leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: Aeaching fields,number, dimensions: 4 8' c 4 8'x 6" overflow cesspool,number: innovative/alternative'system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): CESSPOOLS: n o (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: na Depth—top of liquid to inlet invert: n a Depth of solids layer: na Depth of scum layer: na Dimensions of cesspool: na Materials of construction: na Indication of groundwater.inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,leyel of ponding,condition of vegetation,etc.): Ce'6hpooiz not ae.6ent" PRIVY: nO (locate on site plan) v Materials of construction: na Dimensions: na Depth of solids: na signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Comments(note condition of soil, 112iv 11 no" 2ehent.l 9 - r Page 10 of 11 OL4.L.MSPF.',3rtQN'.FO"RM"NOT'�'O QIa JI�'FA�t' :ASSESS NTS OF /—` SU$SURVACE•'SEWAGE.1lt�SC PAR jjjT19 INSPEG�'�30�!i:FORiV'f SYSTEM VMRMATI.ON(nontimled)' Property Address: 1006 Caa ipv.i.2.ee BP-ach Rd,,unit 8 .�nnfon u.i p.Qp - (72. Owner. Date of Inspection: SKETCH OF SE'VVAG)•DISpOS kL SYSTEM Provide a sketch of the sewage disposal system including ties to at least ea er two ply entorstthe b O ding �ar�or benchmarks.Locate all wells within.100 feet.Locate where pu uPP. r o 0 x Ilk a 1.0 - . Page 11 of 11 OFFICIAL INSPECTION FORM=NOT FOR VOLUNTARNTS StjJgSURFACE SEWAGE DISPOSAL� CYSTEM INSPECTION FORM SYSTEM INFORMATION(continued) Property Address:/006 ' C2a.i v.i.eee l3e_gch / d1 unit8 en eavi��e. Ala. Owner: 7heodo/ze Ky2o.3.� Date of Inspection:Z 1 0 5 A SITE EXAM Slope Surface water Check cellar. Shallow wells Estimated depth to ground waterf'! feet Please indtcato(check) .all methods used to determine the high ground water elevation: , . 9999 y e,30btained from system design plans on record-If checked,date of design plan rgviewed: y e hObserved site(abutting property/observation hole within 150 feet of.SAS) e ecked with local Board of Health-explain: «-s Z u.i y Ch t documentation) ch docum Checked wtth local excavators,installers-(attach y e_,3 Accessed USGS database=explain: h t t=�wn a 2 n�s -a e•'m a•'u �--. You must describe how you established the high ground water elevation: used;Gahert & Miller model 12 1 used•USGS observation w 1 used- :'Technical bul — — wa er a eva ions. t Leaching ;eet Groundwater: Feet Below Bottom-of Pit High Groundwater Adjustment 1.8 ft per 1 irnpte�Method f Therefore,the.vertical•separation distance between the bottom of the leaching pit and th.e adjusted groundwater table is feet: 'e • tt i 00 :r•rrnt+r rnr•rat'TT�arre—mr:nrsets•rtRasnrrrlrr:•nT!7mrl'IrrTtiTrt++'s Ti=W%`uitrF`asTaRR:t TtrTTT�.ti'r:T"': Tr.r"••�: TOWN OF & R VjY:A&k BOARD OF .HEALTH SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM -. PART D •- CERTIFICATION S.•4�T•:`::s�T4TT«�TTI7fS!7ui'R.7SI T.t4CiSGifYSTT.T7'T.•.'IT•'StTTRT16...-7T7Rr'T •�'T�t•� 7'iRf I.TSI^l"T''7T`'II•••••� -TYPE OR PRINT CLEARLY- PROPERTY INSPECTED STREET ADDRESS 0o ASSESSORS MAP, BLACK AND PARCEL. 0011 _ OWNER' s NAME PART D - CERTIFICATION NAME OF INSPECTOR Ro&e-at 1 a.o-4zn4_ l � COMPANY NAME doze/2h .l Nacomle2' 9`.Son Inc COMPANY ADDRESS Box 66 Cen;te2v.ir-9e Nazz 0Z63Z Street Town or City. State LIP COMPANY TELEPHONE t 508 1 775 - 3338 FAX ( 508 1790 - 1578 CERTIFICATION STATEMENT I certify that I have personally .inspected .the sewage disposid system at this address and that the information reported is true ,. accurate, and omplete as of the time of•insp.ection . The inspection was performed and any recommendations regarding upgrade , maintenance , and repair. are consistent with my trainip,g and experience in the proper function and maintenance of on- site sewage disposal systems . Check one:VV ; Systetri PASSED ' The inspection which I have conducted has...not found any information which indicates that the system fails to adequately protect .public health or the envirojiment as defined in 310 CMR. 15 . 303 . Any failure criteria .•not evaluated are as stated in the FAILURE CRITERIA section of this. form . System FAILED* The inspection which I have con Tcted has found that the system fails to Protect the public health and the environmen-t in accordance with Title 5 , 310 CMR 15 . 303 , and as specifically noted on PART C FAILURE CRITERIA of this inspection form . Inspector Signature Date ecopy of this certification must' be provided to the OWNER, the. BUYER On where applicable) and the BOARD OF HEALTH. . * If the inspection FAILED, the owner or operator shall upgr.ade '.the system. within o'ne year of the date of the inspection, unless. allowed or required otherwise as provided in 3:,10 CM.R 15 . 305 . .--- par..td.doc TOWN OF BARNSTABLE LOCATION/ C SEWAGE # O � VILLAGE ASSESSOR'S MAP & LOTtub i l INSTALLER'S NAME & PHONE NO. A & B CANCO 775-6264 I SEPTIC TANK CAPACITY 94:W S•Y' 0) .. ...•T v,4«.,,.el ��r d� t"i'C� (size) 21 f x y7 X �. i `LEACHENG FAC.L...T i o%%.�r- NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER 4BUILDE.R OR OWN_ r DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: �'� VARIANCE GRACw NTED: Yes No ! � Na t i 0 O O � � o• 1 } No. ' d �fS✓ Fee �© THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ve, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Mie;pozar 6potem Con5truction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ElComplete System ElIndividual Components Location Address or Lot No. �0O /'q;G tJ t /� G�1/I wner's Name,Address and Tel.No. I CC)TA V 141� Assessor's Map/Parcel ss,as W Installer's Name,Addredl.CANCO esigner's Name,Address and Tel.No. 350 Main Street eat f'� �coZ 8"l 3�, Type of Building: Dwelling No.of Bedrooms /J Lot Size S! 761 sq.ft. Garbage Grinder( ) Other Type of Buildings met- dA314,A No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow /(a So gallons per day. Calculated daily flow 00 C gallons. Plan Date Number of sheets Revision Date Title ie t ` Size of Septic Tank a— cone Type of S.A.S. A-c-ree A fLe/co Description of Soil Nature of Repairs or Alterations(Answer when applicable) P-P / 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 Environme l Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Board of Ik lth Signed v e Date Application Approved by Date 121 Application Disapproved for the following reasons Permit No. � Date Issued ,I � 9 ,No. d%T •' [/ ..�--±c Fee-- S Entered in computer: " THE COMMONWEALTH OF MASSACHUSETTS b Ve, PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Zipplication for 13iopozal *pgtem Construction Permit Application for a Permit to Construct( )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /00 /q iG V Ile / �i��1 wner's Name,Address and Tel.No. �) Assessor's Map/Parcel Installer's Name,AddresTiNp�A Designer's Name,Address and Tel.No., g/ s,@n1 1C 350*4aln Street Pd4 ) '?, Type of Building: Dwelling No.of Bedrooms / Lot Size sq.ft. Garbage Grinder Other Type of Buildin un�n,cr No.of Persons Showers( )' Cafeteria( ) Other Fixtures Design Flow S U' gallons per day. Calculated daily flow 7 U S gallons. Plan Date Number of sheets Revision Date Title SP 0'j%c �V s�c n" L Size of Septic Tank 0- o?ooc SA I. Type of S.A.S. X Description of Soil - Nature-of Repairs or Alterations(Answer when applicable) Date last inspected: r. } i! 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 Environme al Code and-not to place the system in operation until a Certifi-, cate of.Compliance has been issued by this Board'of I 1 Signed od `J Date /0 / L OU Application Approved by _ _ Date/6 /�'.�'d Application Disapproved for the following reasons r Permit"No. ,Ze�0 4-L5,10 Date Issued 'V --------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired(graded( ) Abandoned( )by UC h _ at 1064 (21A i c ri 1/ZP 2 U re i A has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit N;& 6 4�!6 da ed Installer Designer The issuance of this Irmit h nit be construed as a guarantee that the sy��s i�ll/ffunction as designed Date,__ Inspector 1��'/� r I` No. ,1. --------------------------Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLEs MASSACHUSETTS MisSpogar OpMem uCongtruction Permit Permission is hereby granted to Construct( )Repair(Upgrade Abandon System located at / !t h U C�/.a: ;/ r a ✓.'/ Q_ mot, / �� A y0 / A ' and as described in the above Application for Disposal System Co struction Permit. The applicant recognizes 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 rmit. Date: ��`F�i' �'`') Approvedj;y,.."* A PROVIDE CLEANOUT TO {., '�`1 9• MI NI MUM COVED GAS SHUTOFF � GRADE AT ALL CONNECTIONS � c - FIRST 2 ,f6 © I N VE' •` T ELEVATIONS : DESIGN CRITERIA : TO EXISTING PIPES ©WATER SHUTOFF SEE PLAN 4• PERF PIPE INVERT AT BUILDING: ACCESS. COVERS MUST BE WITHIN _ BE LEVEL' '' MIN. 2' OF INVERT IN SEPTIC TANK s/: 4.5 SEPTIC TANK REQUIRED: *l TEE` ' ` t 4•vENT 4.25 6 BEDROOMS A T 110 G.P.D. PER 6' OF FINISH GRADE PEASTONE C;4 Eo 3 • `� , 5.S BEDROOM EQUALS 880 G.P.D. f' --- i � � INVERT,OUT SEPTIC TANK #1: •.1 y^ 8.86 2x--_y Ia MrN e.r I J.b INVERT I N SEPTIC TANK •2: I ' � * 5.25 680 G.P.D. X 200V - 1760 GAL. - op,t� I �r -�-^ �.r40 MIL POLY INVERT OUT SEPTIC TANK 2. SEPTIC TANK PROVIDED: 2000 GAL. MIN. u }Q o0oq°0•0 0 5' P.R SPK EL- 75 1 . C VAPOR BARRIER T INVERT _11 PUMP-CHAMBER: 4. 15 2" SCH 40 PVC I�l - f �! '` ( 4' SOLID D PIPE a,r I �` /` 1 I t a ''�• INVERT bUT PUMP CHAMBER: 4. 15 AN �� #/,4.25 / r �' � ! r SEPTIC TANK REQUIRED:GA S *! ..� _ 3/4' - 1 1/2- D1A. 7.e:; * 4 ' BAFFLE *2.5.25 9 OUT '? - ,5 +c`ja r l !j EOW I }. INVERT 1N DIST� BOX: 8 0 7 BEDROOMS AT 1/0 G.P__.D. PER 48'x 48' LEACH FIELD __ a F LET 4ASHED STONE , -- js•s4 �• ow 2 L. =-"r a 3• INVERT OUT D/ST: BOX: '7.83 *2.5.5 4 �7-BOX r- 7.46 //6 4g T: I I3. BEDROOM EOUALS 770 G.P.D. " c QI t r _ / % /6 °0: I a \Q� INVERT IN LEACH FIELD: -'7.61 770 G.P.'D. X 200x - 1540 GAL. 2000 GAL H-10 H-10 PUMP CHAMBER - *$ °{ 1 r/ / �, INVERT END;LEACH FIELD: 7.37 SEPTIC TANK PROVIDED: 2600 GAL!--*IN. r SEPTIC TANKS WATERTIGHT AND - WATERTIGHT AND r \y/ FACTORY WATERPROOFED 7,63 e l{ 7r �olr A2 / / BOTTOM LEACH FIELD: 6.87 ? 5 ' ;. lCK7 � _� l FACTORY WATERPROOFED 1' , \ P ~� i / LINE BEARING DISTANCE ADJUSTED GROUND WATER: 1.87 DESIGN FLOW: TOTAL _a ` aR��ti i A ' •�: i i 213 OBSERVED GROUND WATER: 0.37 15 BEDROOMS AT 1/0 G.P.D. PER 6' CRUSHED STONE BASE � ! � f• \ cF j �A .�� , � I // BOTTOM OF TEST HOLE: `0• l BEDROOM EQUALS 1650 G.P.D. f "� � 4 ' -� a•6 o � :i ( Eow II L 2 S 86 l7'10'W 5. 10' V .? INDEX WELL M/W 29. ZONE A PROF I L E : NOT TO SCALE I Q' e PQ 7 }s S� /P APRIL 99 READING- 8.0 '. ADJ-! '-` SOIL ABSORPTION SYSTEM REf?UIREDr " \ 5 DESIGN PERC RATE ! 5 M/N/I NCH 1 SOIL TEXTURAL CLASS - I EFFLUENT LOADING RATE - 0.74 GPD/SF yl 7, 0 .g° I t i II I! 1650 GPD / 0. 74 GPD/SF - 2230 S.F. REOU I RED GENERAL NOTES : Ow +7 5 0 ,t1 PROVIDED: 48'x 48' LEACH FIELD r r 1 ! Eow ro AREA - 2304 S.F. x 0.74 - 1705 G.P.D. I. THIS PLAN IS.FOR THE DESIGN AND CONSTRUCTION ' -, �' I I . 1 I 2.6 OF THE SEWAGE DISPOSAL SYSTEM AND PERMITTING ONLY. 2. VER T I CAL DATUM IS NGVD. FOR BENCH MARKS / O P SET. SEE SITE PLAN. � ��' _ -- � � , o I /` l I r ! SO`#l�L TEST P l4T. DA TA s r r j I 1/ t: ,ac t F fOw 5 � ... ` 3. ALL CONSTRUCTION METHODS AND MATERIALS I AL S AND _ _ I r Q r i INDICATES l ND 1 CA TES 0 "3 7 r I �/ PERCOLA TON OBSERVED r. � I �' // � o � � � m: ; II Il' TEST - GROUNDWATER MAINTENANCE OF THE SEPTIC SYSTEM SHALL ,, / v+ ► o / , CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL Pw9379 BOARD OF HEALTH REGUL A T/ONS: o : 4! -100' TO TOP OF eaNK ,T► �6/. O. HORIZON TEXTURE COLOR 7.7 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDER ;i ' a•e �r�c 6`� r F j AREAS SUBJECT TO VEHICULAR TRAFFIC OR GREATER \ ' �' / - 100' TO WETLAND I� x it nl 1 6• F/ L L 7.2 THAN 3' IN DEPTH SHALL BE CAPABLE OF WITH- I c Y / r r r r ?ow 9 STANDING H-20 WHEEL LOADS. 3 I Eow 3 ---�QR r t c� II 3 A/B LOAMY IOYR t J� SAND 3/2 / 5. ALL SEWER PIPE SHALL BE SCHEDULE 40 OR Eow 4 16. 6.4 APPROVED EOUAL. a 6.8s /501W 2 ;r`v J b 91 6•Cy I 6.; / I I 15` i 6. SEPTIC TANK, PUMP CHAMBER AND D-BOX SHALL BE �loo• �, ECEcr, rc TO WET .w MA.vNolE C / MED I UM I OYR REINFORCED PRECAST CONCRETE. WATERTIGHT AND ;f LANp �°/ �' ce O 7.0 g Q S #8 I r ' �� 1 t SAND 5/3 48' WATERPROOF. a.9 -N P D�oo,If 5 e /r ;r h j/, �;- "tow e 7. BEFORE CONSTRUCTION CALL "D/G-SAFE'. ti0 q N�•s?? r r t 88' 0.37 y 1-888-DIG-SAFE AND THE LOCAL WATER DEPT. �`� t <- r r i FOR LOCATION F '- - I 0 UNDERGROUND UTILITIES. Ilk, 1 _ ' '} CESSP00'S 6.e 1 � r I A� •� t 8. EXISTING CESSPOOLS TO.BE PUMPED DRY REMOVED. 1 ® r t t/ a.a 4 7.p / h.e Iy •� V Eow 7' 2.s ! 94 -0. l _ CLEAI)OUT ®\ 5 2 �� t r a•2 \ r k DATE: APRIL 1'5. 1999 BACKF/LLED AND COMPACTED. \ #/ 1r \t `I 9. ALL UNSUITABLE MATERIAL (FILL•A ct B HORIZONS) / %s.az 6.7 ,�oo6GAt r: �� ;;/ / TEST BY:. STEPHEN HAAS ENCOUNTERED BELOW THE INVERT OF THE LEACHING SEPTIC TANK ,•8 � r ' \ WI TNESSED BY: DONNA MIORANDI t ,.r FACILITY TO BE REMOVED FOR A DISTANCE OF 5' / ® ? BED o� rfss?car. c , I �' ti Eow 6 PERC RATE C MI / N CATCH BASIN ' / 2 N I CH AROUND AND REPLACED WITH SAND IN ACCORDANCE - RIM-6. TOF•6,Ppp/.!S h �.7 ifi S i WITH llTLE 5. 'D � ?500 GAL r > •9 i 6g PUMP. CHMBfR` // I � :it ti. 8q 3j SO 1 \ I 0. THE EXISTING WATER SERVICE I CE TO THE INDIVIDUAL/V/DUAL / r k / V #2 ?Oop GAL f _ BUILDINGS IS TO BE LOCATED AND EITHER MOVED TO -` 0. 0� SEPTIC TANK ® tih\ BEL' • !0 FEET FROM THE PROPOSED SEPTIC SYSTEM OR SLEEVED \tom, r , . r , ' ) MERCURY FLOAT CA TE YE FOR A DISTANCE OF TEN FEET AWAY FROM THE SEPTIC ATCH BAST , CESSPOOL �'7 2 ToIc. oo,"s r ,�� 4' PVC INLET, swrTCHEs ' PVC OUTLET SYSTEM. RIM-6.26 / I' !r % Eow 4 ALARM AHD } t _ ALARM \ , / I 2.A LAO PIMP OH� WEEP t 7.0 CLEAN- i r I , I I1. THE EXISTING GAS. ELECTRIC. CABLE TV AND TELEPHONE /� 6.54 I our r ' \ r 1 POOP d" CHECK LINES ARE TO BE LOCATED AND MOVED AS REQUIRED-FOR ,l :cfssP�a. f 7 \ /' ! PUMP �i�• Raw THE INSTALLATION OF THE SEPTIC SYSTEM. \ r! I Two Prams / CESi. ocu # 5.3 r r i / 14*$LU 7.3 /� 6., ELF.CTRI4 \�\g jr rrii L lhT 6 MANNOLE t I / op _ \ t PUMP DE TA I L :NOT TO SCALE • YL 1 .5 1728 t,+ S. F. t t USING 2500 GAL. SHOREY ST-2500-H-10 Q • ��_� \\ r, t 1 _.EOM 3 OR.APPROVED EQUAL. WATERTIGHT AND WATERPROOF .5.E 1 7.4 TCH BAST r' / 7.5 UP 84A� 1 5 3 t 1 O r Rop t 0 PUMP SYSTEM NO TES: c R IM-6.14 I ? BED �`'� '�S 'NY• \ 1 i O O a L�O I / �//ti /�/� �/ CALCULATIONS : �� I l`l /L T I O N l C` / 6.32 7 3 s6 6 s� ' I 1 i 1. PUMPS TO BE MYERS RESIDENTIAL SEWAGE PUMP MODEL SRM4 LJ V / A/ Y / 1. I_ (� (J l�l SJ I t. l A b 7 r OR APPROVED EQUAL. SEPTIC TANK #/: DISPLACEMENT - (1.87.0. 1) x 12 x 6.5 - 154 C.F. t e`S `� t h 4 3 i ' cf 1 2. THE PUMPS SHALL ALTERNATE AND START AND STOP AT THE ELEVATIONS 154 C.F. x 62.4 */C.F. - 9610*• H-10 TANK - 14/60* OK 6• c.a + BED sllowN. SOIL REMOVAL 7 J sB 'MS tj , J. THE PUMPS SHALL BE INSTALLED IN STRICT CONFORMANCE WITH l0 SEPTIC TANK *2: DISPLACEMENT - (1.87-0.9) x 12 x 6.5 - 76 C.F. t `F SEE NOTE 9. THE MANUFACTURER'S SPECIFICATIONS AND TITLE V REGULATIONS. 76 C.F. x 62.4 /C.F. 4742*. H-10 TANK - 14/60* OK 1 7 !4 r / 1 PUMP DISCHARGE SHALL B S. PUMPS SHOULD BE ABLE TO BE d i h 11 * o,� r / 1 DISCONNECTED AND LIFTE THE PUMP CHAMBER WITHOUT HAVING TO ENTER THE PUMP CHAMBER. r: PUMP CHAMBER: DISPLACEMENT - (1.87.1.65) x 11.83 x 6.33 - 279 C.F. = D-BOX 40 MIL POLYP 279 C.F. x 62.4 */C.F. - 17410*. H-10 TANK - 22560* OK .� t �' =_ I VAPOR BARRIERi � '� 1 i 4. THE ALARM SHALL START AT THE ELEVATION SHOWN AND BE POWERED BY A CIRCUIT SEPARATE FROM THE PUMP POWER. EOW 2 1.9 TP rr - II -� �r7 '`! ; too t0 ,TI AD I I I I +6.77 4 / � � �I �� r i /Sp S 6J'• ,� I 17 -} I qCy I , I ri ;r / 4 1 N ) e • Op. 2� 7.B, �,I ° 59 .4 �s gyp. S F P T / C S BM. RR SPIK v•r�.83 EL-7.04 _ I8. � II 16.2 It CO R,4 L V / L L ,4 OE- A, STONE Y4tt II Ii lI. �r `, Ir i rI � 6.99 OO6 C(RA / G V / L L E BE•A CH RO "A P 226 . e CATCHBAS/N 30 TpAEMAtt SIGN 7, 4`/ II iyll�Jt�r h O t y RIM-6.88 O O YE 6 / �Q h rt \ ti S A S /�0 S TA R L. � < CE/V TER V / L L E > �V� NT • A 7.7 STONE / y PREPARED FOR w4tt , ' 4 j� oqs sF 7.7 Q /� + L RFC p�E�CLr �G B� UP 64 ! 1 / V/ / C F� C� /V / /�/ T f� 7.4r w; s P . 0 . SOX / 6.5 . BEL MOM . MA 02478 t SC.� L E . / •' - 20 SEP TEMBER / 4 / 999 EAGLE SURVEY I NG 1 NC IVER CENTERVILL 923 Route 6A f �LOC �� Ya rmou t {� po r t MA 02675 {' / ( 508 ) 362-8 1 32 r / .� { /I I y� /{ 508 432-5333 f BEACH ROAO CRA/ • ACN LONE BE RD e, CENTERVILLE HARBOR LOCUS MAP 0 10 20 40 JOB NO: 98- 128 FIELD:CFW/EEK CAL C: SAH/CFW CHECK: CFW DRN: SAH