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Home My WebLink About0243 HUCKINS NECK ROAD - Health 243 Huckins Neck Road Centerville A = 252 - 119 S M E A D9 No.2-153LOR UPC 12SU smead.com • Made In USA SALAMS A. ImuntimWOOOMICE SFImumamm ��M CERTIFlED SOURCING YYNM1N.SFNEOGRAM.ORd Town of Barn> tble Department of Regulatory Services F Pubhlc He�i>h D><von . ate 200`Main Street,Hyannis MA 02601 `•, • :. Date Schediiled Time Pee Pd Soil Suitability Assessment for Sew. .gesposal Performed By 2 � i `e— �-2 e +54Z)Witnessed By" 1 LOCATION&.GENERAL INFORI�IAT10)\T Location Address s C'er�h_k. ltk. tZ Address Assessoe.s Map/Par^oel: C% Engineer's Name NEW CONSTRUCITON REPAIR Telephone# 56 —7 3.7-q? ro�( Land Use Res 4ey\4 f ct I Slopes(3a) Z_ Surface StoneszC Distances from: Open Water Body_L��-'_ ft Possible Wet Ann IA— ft Drinking Water Well ft f Drainage Way ft Property Line I S "—ft .Other ft SKETCH:<(streername,dimensions of lot,exact locations of tesuboles&perc tests,locate wetlands 1`n proximity to holes) �C 043 IS ., COD Parent material(geologic) �y F-•}�a� �� Depth to Bodmck (A- Depth to Groundwater. Standing Water in Hole: /Jh--: Weeping flour Pit RRGe Estimated Seasonal.High Groundwater DETERMINATION FOR'SEA'SQNAL HIGH WATER TA A E' Meths Use-4 Depth Observed standing in obs.hole: in. Depth to soil mottles: in side of ots.tole: its, Index.Well:# J Reading Date: Index Well level Ad(j,&ctor Adj-Ciroun'dwater Level,,,m, PERCOLATION TEST Bute— — Observation Hole# 4-eil— Time at 9" Depth of"Pere CA 47 1"k Tlme.nt 6" ...........a �� Start Pre-soak Time® Z f t A C Time(9".6") End Pre-soak Rate MinAnch Site Suitability Assessment: Site Passed L_ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- .,***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1)week prior to beginning. Q:\SEPTICIPERCFORM.DOC 1 DEEP:OBSERVATTON HOLE LOG Hole# Depth from Soil Horizon Soil Texture. Soil Color Soil Q�er Surface(in.) (USbA) (Munselq Mottling (Structure,Stone ;Boulders: Mfg�>L yp-132 C-2 41,J az� DEEP O 'S1JItVATION HOL1;IOG Hole# �-- Deptlrfrom Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Bouldem Icniv ` _ n I �o Y,Ls t; DEEP OBSERVATION HOLE`LOG Hole# Depth'from SoilHorIzon Soil'Texture Soil:Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure.Side*,Boulders. DEEP OBSERVATION HOLE'LOG Hole# Depth-.from Soil Horizon Soil Texture SoiI:.C°lor Soil Other Surface:(in:) (USDA) (Munsell) Mottling (Structure,Stones:Con Boulders. Flood Insurance lfate.: an: AboKe""Sob,year`flood boundary N°— Yes` _` Within S00 yearhoundary No IL Yes..,;_. We. 4. ithin l00 year flood boundary Nor Yes De�t_h of Nattaxallv"Occurring Pervtotu:-Material Does~at•leastTfour>reet of naturally occurring pervious inateriaLexisrin all`aretts;observed throughout the; area proposed for the soil absorption system? - J. If not,.what s the depth of'naturally occurring pervious matdriiil? Ce CA q IL. P I certify thaton i� (date)L.have as se&the soil evaluator examination a proved l� the P , De artment of Environmental Protection and that the above analysts was performed by me consistent with •* . P . the r"eytured trai"fng;expeitiselri expendnce descnbed"in 310'CMR 15:017: Signature Date (� Q.�$BP'1'IC�ESRCBORM.DOC 7 /Q w;�J � �v No. J ~ 4 1� Fee f THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitatlon for Misposal *pstrm (Construction Permit Application for a Permit to Construct( ) Repair(.4u pgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or[of No. 2 93 yrt r.rNs /NPeG Owner's Name,Address,and Tel.No. rv.11 Assessor's Map/Parcel S 2. Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. �Ct15�G�r1 �o$C7vo� �NC 0rv51Nle rd,-1J Soy-` 00 ) Type of Building: Dwelling No.of Bedrooms Lot Size I�� j sq.ft. Garbage Grinder( ) Other Type of Building k cpOS 4L. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'"3 Q gpd Design flow provided lj \ gpd Plan Date Number of sheets `.Z.. Revision Date Title Size of Septic Tank Type of S.A.S. LL C 1►�cr✓�.kne PS Description of Soil Nature of Repairs or Alterations(Answer when applicable) r Q , Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' d ��—�=— Date Application Approved by Date Application Disapproved b "`-_ Date IF for the following reasons Permit No. 0 05— Date Issued Al No-1 Mz— d '' Fee too d—� THE/COMMONWEALTW OF MASSACHUSETTS Entered in computer: r ill PUBLIC HEALTH DIVISION -TOWN OF--BARNSTABLE, MASSACHUSETTS Yes applicatiDu for Mi!6posal 6pstem Construction permit Application for a Permit to Construct( ) Repair(Upgrade Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 2 IK')[1 NZ, /J eG k. —12<) Owner's Name,Address,and Tel.No. G�rer v;l l`P Tw,',a L4`c(-S Assessor's Map/Parcel Innsstaller's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. N-26f&,,) J 1:NC �O -r , GNC INY A✓ �y Type%of Building: 1 _I J �l� Dwelling No.of Bedrooms '7, Lot Size �y�3 Di/ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Flow'(nih.required) �gpd.__,4D'esign flow.-provide`d4.:-y�f \ j �__ .:-_ _..gPd. r Plan Date Number of sheets ',Z„� Revision Date Title Size of Septic Tank (f)&1!!,;-,N a Type of S.A.S. L�_ �, r�Che-A tole rr, Description of Soil ,�_-• Nature of Repairs or Alterations(Answer when applicable) E<'Tsc 11 �� p —A Date last inspected: Agreement: s The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' d 2--- Date Application Approved bye2,14C—ys� Date Application Disapproved b for the following reasons Permit No. 20 l,27^ I'2.. Date Issued Jig ,-70/3 - ------------------------------- ------------------------------------------------------------------------------------------- Th 1Z COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS _ Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( "-,,"'Upgraded( ) Abandoned( )by at?LI '��L1,,, ), .;"� A) has been constructed in accordance with the provisions of Title the for Disposal System Construction Permit No. Ial l dated 5/7—A Lro#3 /� 1 Installers) -mole- 4An.�� 4'-,.;� Designer �',"� „�',.,r;,o C I[g, #bedrooms Approved design fl w 3 3 0 gpd �;�, The issuance o this permit shall not be construed as a guarantee that the system wi 1 fu dtilon as designed. Date Inspector f S r -- -------------------- ---- ----------------------------=---------_---- ---- ----- ------------- - No G� Z Fee 00 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS his osa[ �pstem onstruction 3Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) System located at 2 -�--;1 dE\4',,J!% IN)ge E IC !�s�r",�•�� v r,1 �,1•� and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following lodarprovisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date ZA► Approved by ZZ 06/10/2013 13: 51 50134775313 ENGINEERING WORKS PAGE 02 Town of Barnstabk Rqpbt y Se rvim Thomas F. Ceiler,Direetor Pubfic Beam DM* Thomas McKeaa,Director 200 Main Street, Hyannis,MA 02601 Office: 5$8 IM-4644 Fax: 50&7"-eO4 Date: Sewmp PermitO Assessor's h1sWarcel 257— —11°l der�I>�si�mer�rSsr�S� F. rm Designer: l~n ? rs•R�w�'. W e 4 s� 1nr , Inst$iier: �V4-;b W n I n Address: i i W. Ccb r.'s CPC I al teal, Address: p a `—X f'-tS` On was issued a permit to install a '�`I 3 �c��ru septic system at based on a design drawn by QA1 M,L�W P� ( ss ` ° r- dated 26 �y 1 (designer) I certify that the septic system referenced above was installed subst=Wly according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank, Stripeut (if required) was inspected and the soils Were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any corapomt of the septic system)but in accordance with State& Local Regulations. Plan revision or certified as-built by designer to follow, Stripout(if required) vv ted and the soils were found satisfactory. OF. RET1!~R T, 'EN TEE staller's ignatum�T CIVIL y No.sates igner s Signature) ( x esxgn PUL4WE-BETURN TO BARNT TE CE N OTH Tffi Z=CARD ARE RECEIVED BY THE BARNSTABLEP q;loflm formWonip mwtiBaaUon fomt.doa �r LEGEND r N -- 47 -- EXISTING CONTOUR l` Locus x 48.23 EXISTING SPOT GRADE 44 PROPOSED CONTOUR -W EXISTING WATER SERVICE -G EXISTING GAS SERVICE I a 6 -U UNDERGROUND WIRES \� IS TEST PIT / BENCHMARK 45,80 �n �\� Wequaquet Lake _ LOCUS MAP O + 6.01 NOT TO SCALE C S oa U 9P 46.50 A ot� s -� 47.15 �O 0 700 2s,, O 47.01 / 47.27 ::: 47.74 - 47.97 47.57 / LAMP 47.62 48.12 LOT 82 .•APN 252-119 Q . i 19,143±S.F. 47.88 x x 47.18 47,91 47.93 _- � x 48,2 47.85 . / oORcy \x 46.93 47.91: 48:42.. x �8.14 . : l /EXISTING x 47 6 TBM HQUSE( 4 ..qr d ..+Lac_.. ..►�"-�- - OUTSIDE-,CORNER l T.O.F.=49.16t SOTT. STEP= EL.=49.06 47.96 x LL L W 48.23/ 47.60 47.94 X I DECK i x• 0) a x 48.14' I ��. '0) N 47.80 x Sh, T M ��: ;� 47.65 49.06 ' N Ss 4 , 8.23 , o: V O 1 ate= Z O 48,07 ►� v \, 48.09 ' EXISTING SEP77C TANK o x 47.91 - `ZYTP-1 .47.75 (TO REMAIN) TOP OF TANK, EL.=36.64 i- .Tp 2 INV.(OUT)=45.30t I, PI 47. 1 + 47.95 EXISTING SA.S ' TO BE PUMPED, FILLED WITH \ 47.33 - x 47.55 SAND AND ABANDONED. 31 �7.07 :.:. 7, .. v 47,13 46.73 : per.: o o . 46. 9- , : : ��Z ' 46.3 q 46.37 R=1129.23 G-1010' �.4.6. �46- E TE 46,02 edge of pavement T46.02 46.03 45.36 45.49 MAG. N I 46.01 BENCHMARK SET EVIEW A VE. M .=46. C NAIL SET LAKEL46.D1(BARNSTABLE G.I.S.t) OF MqS o PETER T. �, PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE N 243 HUCKINS NECK ROAD, CENTERVILLE, MA CIVIL No Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 . 35109 �0 OWNER OF RECORD R£GISZE� `��` Engineering by: SCALE DRAWN JOB. N0. + �F S EN TWIN LAKES LLC Engineering Works, Inc. 1"=20' P.T.M. 145-13 243 HUCKINS NECK ROAD 9 9 CENTERVILLE, MA. 02632 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. (508) 477-5313 5/24/13 P.T.M. 1 Of 2 -� NOTE: TO PREVENT BREAKOUT, THE PROPOSED ! FINISH GRADE SHALL NOT BE < EL: 44.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL H-20, WATERTIGHT INSTALL H-20 WATERTIGHT RISER, FRAME & COVER OVER OUTLET AND SET TO 6" OF FINISH GRADE RISER, FRAME & COVER ONE CHAMBER(MIN.),AND SET TO FINISH GRADE TO SERVE T.O.F.=49.16 SET TO FINISH GRADE TO SERVE AS AN INSPECTION MANHOLE. EXISTING F.G. EL.=48.1 t F.G. EL.=47.5t F.G. EL.=47.3'± CHARCOAL VENT i L = 26' L = 17'( ) ® S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC s _ 1 2" LAY;R OF 1/8" tot ®0® TO 1/2 DOUBLE .- 14" s 12" WASHED STONE EXISITNG 48" LIQUID INV.=45.30± (OR APPROVED FILTER FABRIC) LEVEL INV.=44.20 4' 3' 4' 3/4"-1 1 EXISITNG PROPOSED 2"/ GAS BAFFLE DBOA EFFECTIVE WIDTH = 11' DOUBLE WASHED INV.=44.37 H-20 RATED INV.=44.00 STONE EXISTING SEPTIC TANK USE 5 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 4' OF DOUBLE WASHED STONE-ALL SIDES NOTES: H-20 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=44.83 -BREAKOUT INVERTS, PRIOR TO INSTALLATION. -- �E3 - 2) D-BOX SHALL BE SET LEVEL AND TRUE TO INV. ELEV.=44.00 E3 E3 EO EA® ELEV.=44.5 3M GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=43.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' 5 x 6' = 30' 4' 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING 3) INSTALL INLET & OUTLET TEES AS REQUIRED. PERVIOUS MATERIAL EFFECTIVE LENGTH = 38' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. AS MANUFACTURED BY TUF-TITE, ZABEL OR EQUAL. LEACHING SYSTEM SECTION ESTABLISHED HIGH G.W., EL=34.80 -_ (WEQUAQUET LAKE WATER SURFACE) SEPTIC SYSTEM PROFILE N.T.S. SOIL LOG DATE: MAY 1, 2013 (REF. P#13,936) SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) WITNESS: DONNA MIORANDI R.S. HEALTH AGENT Elev. TP- 1 Depth Elev. TP-2 Depth 47.9 A 0- 48.0 A O„ GENERAL NOTES: SANDY LOAM SANDY LOAM 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 47.4 10YR 4/2 47 6 1OYR 4/2 BOARD OF HEALTH AND THE DESIGN ENGINEER. B SANDY LOAM 6" B SANDY LOAM 6" 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 10YR 5/8 10YR 5/8 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 45.9 C1 24" 46.0 Ct� s 24 •_ - _ _ _ LOCAL RULES-AND REGULATIONS. '"- M-C SAND M-C SAND 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 2.5Y 5/4 2.5Y 5/4 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10%GRAVEL 10%GRAVEL DESIGN ENGINEER. 43.9 C2 48" 44.2 C2 46" 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN ENGINEER BEFORE CONSTRUCTION CONTINUES. 5. ALL ELEVATIONS BASED ON BARNSTABLE G.I.S. DATUM±. MED. SAND MED. SAND 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 2.5Y 6/6 2.5Y 6/6 THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE 36.9 132" 37.0 132" 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S. NO GROUNDWATER OBSERVED PERC RATE: <2 MIN./IN. (IN SAND-ON FILE) 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY ( --4.-� CrOUT -------1 THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING I 20-aw COVE CONSTRUCTION. 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS - IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 4-KNOCKOUT 4•KNOCKOUT REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE I _ INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. L------ 4 KNOCKOUT 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND L` IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 72- PLAN VIEW 17-1 DESIGN CRITERIA ® ® ® ® ® ® ® 22- TE3 ® EaT INVERT I ® ® ® ® ® ® ® I NUMBER OF BEDROOMS: 3 BEDROOMS 12 SOIL TEXTURAL CLASS: CLASS 1 l 72- DESIGN PERCOLATION RATE: <2 MIN/IN DAILY FLOW: 330 GPD SIDE VIEW ENDD VIEW DESIGN FLOW: 330 GPD WIGGIN LC-6, H-20 LOADING GARBAGE GRINDER: NO-AND NOT PERMITTED WITH THIS DESIGN LEACHING CHAMBER EXISTING SEPTIC TANK: 1000 GALLON CAPACITY LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF N.T.S. .74 GPD/SF PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 5 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 4' OF DOUBLE WASHED STONE-ALL SIDES 243 HUCKINS NECK ROAD, CENTERVILLE, MA SIDEWALL AREA: (11.0' + 38.0') x 2 x 1' = 98.0 SF Prepared for: D. A. Brown, Inc., P.O. Box 145, Centerville, MA 02632 BOTTOM AREA: 11.0' x 38.0' = 418.0 SF Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:........................................................... 516.0 SF Engineering Works, Inc. NTS P.T.M. 145-13 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(516.0 SF) = 381.8 GPD (508) 477-5313 5/24/13 P.T.M. 2 of 2 243 HUCKINS NECK ROAD CENTERVILLE A = 252 - 119 r ,I SMEADO KEEPING YOU ORGANIZED No. 12534 2-153LOR SUSTAINFOREABLE MIN.RECYCLED INITIATIVE CONTENT 10% Certified Fiber Sourcing pOSTCONSUMER www.54rogramorg SFW1290 MADE W USA GET ORMIZED AT SMEAD.COM TOWN OF BARNSTABLE LOCATION o11J Iti1u(1i rNc NeveIC SEWAGE# 20►3- I ni VILLAGE ASSESSOR'S MAP.&PARCEL 2S CiT INSTALLER'S NAME&PHONE NO. b9,U-5 A- 11 ruw,J 1n,C 6/ SEPTIC TANK CAPACITY C X/f>*i, LEACHING FACILITY:(type) L-C C f ig,"6t15 (size) NO.OF BEDROOMS 3 OWNER/ Iv 1-4�s GG l PERMIT DATE: 2 COMPLIANCE DATE: d Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility perc Feet Private Water Supply Well and Leaching Facility(If any wells exist on` " site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin facility) Feet FURNISHED B / v �} Uv -- 13 ov i - — 42 y Dec 1c r J Ito - s c�� -31 opt �� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments u 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is Centerville, Ma 02632 3/9/2021 required for every page. Cityfrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information f�l ar 16a.y r- filling out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane VQ Company Address Centerville Ma 02632 City/Town State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com 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 3/9/2021 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 243 Huckins Neck Rd Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 5 LC 6 chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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. ❑ 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 c Commonwealth of Massachusetts p Title 5 Official Inspection Form t' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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 L� 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim'Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form � } Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts P Title 5 Official Inspection Form U i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd Description: Number of current residents: 2 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: current Date t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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 c Commonwealth of Massachusetts p Title 5 Official Inspection Form <i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owners Name information is required for every Centerville Ma 02632 3/9/2021 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) ❑ 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: system repaired 6/10/2013 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints in good condition, no leakage, vented through roof. t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 c Commonwealth of Massachusetts F Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1.5 feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �e Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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.7/26/2018 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 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was video inspected and found level and in good condition with no rot. Water level r was even with outlet invert with no signs of past backup. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts r - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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.): s.a.s. consists of 5 LC 6 chambers in a 38x11x1 trench. leaching facility was video inspected from vent and found dry with no signs of past overloading. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. Cityrrown 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.7/262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Vp U Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is Centerville Ma 02632 3/9/2021 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately c v -- 13 OVA — (IrG — 'i2 RACY 17ec lc !to - U,-y, -31 04 ►a D 2 tSmsp.doc-rev.7262018 Title 5 Official impaction Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 243 Huckins Neck Road Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 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: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/2612 0 1 8 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 M 243 Huckins Neck Road �JVtl Property Address Cheryl Mazzeo Owner Owner's Name information is required for every Centerville Ma 02632 3/9/2021 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18