HomeMy WebLinkAbout0088 KNOTTY PINE LANE - Health 88 KNOTTY PINE LANE
Centerville
A= 191 - 100
No. Fee
41C)
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es
01pplitation for 33isposal *pstrm Construction Permit
Application for a Permit to Construct(V� Repair( ) Upgrade( ) Abandon( ) ❑Complete System ndividual Components
Location Address or Lot No. 6% K not{s P ne L n Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel c�M ec u,t(e, _ �� C,du r d G i i se rna r►
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
�' 6 rt,�tca�F�;on 50� �I77 0(053 F lc,hec•i� �nu;fol►,on4G1 -77g.q,qu• I1(,(o
Type of Building:
Dwelling No.of Bedrooms J Lot Size . 4q Acrn sq.ft. Garbage Grinder( )
Other Type of Building ► Fgr,.. horn, No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) S30 gpd Design flow provided 3y 19 gpd
Plan Date Q '7�I q Number of sheets Z_ Revision Date
Title
Size of Septic Tank 1000 gall onS Type of S.A.S. (Z) S-00 %atlon GhA Mb-&t
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) ?%e p(ACe, SAS o nd I) (>ox U S� 0xisi i nq
1000 n0.11nn +o,nk,
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 o alth.
Signed Date
Application Approved by { MY IA. i Date
Application Disapproved by - Date
for the following reasons
Permit No. (�e i I_ Date Issued �r
y
t No. G( � ' �03 F ! Fee d U
* Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS Y
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
Zipoiitation for 33isoosar *pstrm Construction i3ermit
Application for a Permit to Construct(0 Repair( ) Upgrade( ) Abandon( ) ❑Complete System E�,Wividual Components
Location Address or Lot No. �$ K no N Owner's Name,Address,and Tel.No.
Assessor's Map/Parcel C2�12 �,i ¢, a `C,dw�a r cl G i►S 2 nc,n
Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No.
IQ) C3 �c.ACovcz on T09 W'77-0(05 Z ?7+L)C\L1� tl(0(o
Type of Building:
Dwelling No.of Bedrooms 3 Lot Size LH Ac�(S sq.ft. Garbage Grinder( )
Other Type of Building S,)4 i, F n rn No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 1�30 gpd Design flow provided gpd
Plan Date r 1 1-1 J 1 q Number of sheets 7 Revision Date
Title
Size of Septic Tank 1oo0 ocllonS TypeofS.A.S. (2) ,UU a4a0(or, ���CAmiart
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) (�¢p�G a. ��A 3 „sue i� lz,ox u 5 c
J
WOO CX VMot- a r, ,L
�i
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board o ealth.
Signed f,/ Dates
Application Approved by 1A Date
Application Disapproved by Date
for the following reasons
Permit No. �� G� 1 Date Issued
----------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
(Certificate of Compliance �
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( )
Abandoned( )by
of p J(- o has been constructed in accordance
with the provisions of Title 5 d type for Disposal System Construction Permit No.,-0�Gf- f dated
Installer Designer
#bedrooms Approved design flo gpd
The issuance of this ermit shall not be construed as a guarantee that the system wi 1 cf o as desig .
Date } Inspector �l
No. 7 Q — �l. Fee U G-
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 3pPrmit
Permission is hereby granted to Construct( ) Repair(L '� Upgrade( ) Abandon( )
System located at ,
.�
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must be completed within three years of the date of this permit.
Date Approved by
Town of Barnstable
��pftHE Tph� Regulatory Services
Thomas F. Geiler, Director
• MAS& = Public Health Division
�`bAr039. a � Thomas McKean, Director
fD MA'S
200 Main Street, Hyannis, MA 02601
Office: 508-862-4644 Fax: 508-790-6304
Date: S-l y. /q Sewage Permit# Zo I q- IL 3 Assessor's Map/Parcel 1 ql - Io0
Installer & Designer Certification Form
Designer: 'r 66r-rAL Etiu;romcnlm I Installer: jR ii A 6XeruJc��1�
Address: Rox 331 Address: IL4 Tc�rr! LPQ
On S- $- 1 Q B 4 Q jEXC0.V0.J 1o.,\ was issued a permit to.install a
(date) (installer)
septic system at $8 Kno iAu P1 r-,c L based on ai design drawn by
(address)
dated
(designer)
_ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distrillution box and/or septic tank. Stripout (if required) was inspected and the soils
were found satisfactory.
I certify that the septic system referenced above was installed with major changes (i.e.
greater than 10' lateral relocation of the SAS or any vertical relocation of any.component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory. t
DANAD
D.
staller's Sign rt) HERTY,JR.
.
4
(Designer' Signat. ) (Affix Desig p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK YOU.
q:office formsWesignercertification fonn.doc
TOWN OF BARNSTABLE
LOCATIONS? kn.MAQ LO SEWAGE# ZOIc( - I1,3
VILLAGE Q-cmAc.c-u;IXL ASSESSOR'S MAP&PARCEL IS - 00
INSTALLER'S NAME&PHONE NO. -R 4 R EXCayaAt O--, 4')1. OLS3
SEPTIC TANK CAPACITY /000
LEACHING FACILITY:(type) 5o0!jc3-J (size) )3 X Z S A Z
NO,OF BEDROOMS .
OWNER G' G ^
PERMIT DATE: S-$• J Q COMPLIANCE DATE:
Separation Distance Between the:
Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet
Private Water Supply Well and Leaching Facility(If any wells exist on
site or within 200 feet of leaching facility) Feet
Edge of Wetland and Leaching Facility(If any wetlands exist within
300 feet of leaching facility) Feet
FURNISHED BY
AI- Zy '
81"
Al' Z%)
32-' 29
;ZEAR
Ay• *)
o '
3
a
f
4��FTHE Tp��
Town of Barnstable Barnstable
° Inspectional Services 1caC
HARNbTABLE,
MASS.. Public Health Division
i6gq. �� m
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304
CERTIFIED MAIL#7015 1730 0001 4988 2026
April 17, 2019
GILSENAN, EDWARD J TR
88 KNOTTY PINE LANE
CENTERVILLE, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 88 Knotty Pine Lane, Centerville, MA was inspected on
03/27/2019 by Brett Hickey, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Needs Further Evaluation
by the Local Approving Authority" under the guidelines of 1995 TITLE V (310 CMR
15.00) due to the following:
• Septic tank is leaking.
• Staining observed in leaching pit above the top row of leaching holes and in
the stone.
You are ordered to repair or replace the septic system within two (2)years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Vcan, R.S., CHO
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\88 Knotty Pine Lane Centerville.doc
B B OFFICE
From: Stanton,David[David.Stanton@town.bamstable.ma.usj
Sent: Tuesday,April 2,2019 3:50 PM
To: B&B OFFICE(office@bandbexcavation.net)
Subject: FW:Stain Line Question
From:McKean,Thomas
Sent:Monday,April 01,2019 9:38 AM
To:Stanton,David
Cc:Desmarais,Donald;Lavelle,Timothy;Malkus,Karen;McKenzie,Marybeth;Miorandi,Donna;O'Connell,Timothy;
Parziale,Jim
Subject:Stain Line Question
I contacted Brian Dudley of DEP and received the following informatic
If a private inspector has a question about a stain line and he/she fee �—
indicate the system"Needs Further Evaluation." pep
The local approving authority would have to make a final determinati
The approving authority can ask the following questions,to,Has the home been vacant for awhile? 3+ Wetk, �weeRewds) h"� Z�t rs
What was the degree of staining? S+c:%nad over }oe cou air 14 What was the extent of it? Soma Sloan' P„te, "/
I
II
What was the coloration? (Mack �U br
Were there any other indications of failure? S+*.& f-k d•+tcdoc
Did he/she notice any staining in the d-box? W o D-Bew io Sysic
Is it a cesspool or a Title V system? —r. V
The Health inspector may wish to observe the conditions himself/herself.This is at approving authority's discretion.
GondiklonS OIOSeru<A �°~ 'cn$�eolion 88 Knai(� Q;na Lone.
Ick
�k 7wnk hod oat. w of wo+\-cc ,,. kt,a boAcm
4 Ltack, e-V SW.,*6 ov4- i-ap cow of hafts
1
i
vx �r
B _B OFFICE
From: Stanton, David [David.Stanton@town.barnstable.ma.us]
Sent: Tuesday, April 2, 2019 3:50 PM
To: B & B OFFICE (office@bandbexcavation.net)
Subject: FW: Stain Line Question
From: McKean,Thomas
Sent: Monday, April 01, 2019 9:38 AM
To: Stanton, David
Cc: Desmarais, Donald; Lavelle,Timothy; Malkus, Karen; McKenzie, Marybeth; Miorandi, Donna; O'Connell, Timothy;
Parziale, Jim
Subject: Stain Line Question
I contacted Brian Dudley of DEP and received the following information.
If a private inspector has a question about a stain line and he/she feels it is indicative of a potential failure, he can
indicate the system "Needs Further Evaluation."
The local approving authority would have to make a final determination.
The approving authority can ask the following questions,to the private inspector during the further evaluation:
Has the home been vacant for a while? 3-* Weas (weak.4f%d5) 3,000 450M01-4 04 WQAt- 05ed► o,4 V-
What was the degree of staining? S}o►►nod �o(+ rou off- ] p
ov�,r �,Q,c�„' holt..
What was the extent of it? 5 ,ena 51rci.m m_,
What was the coloration? (3Ioc,4.
Were there any other indications of failure? S+o„q ' •, �•!- d�scolo«d
Did he/she notice any staining in the d-box? Wo D- 60 ;� SyS1t� �TantR P�k�
Is it a cesspool or a Title V system? V
The Health inspector may wish to observe the conditions himself/herself.This is at approving authority's discretion.
Condi�ioa3 O'45erU¢d v or '�n ¢C�ion $8 knoi4V
—Tani- had onl-� (o" o4 wo.-tc j, kV c, bAlry\
aK Lead p � S}a; ,eo oY�c fop cow of hales
I�
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
'0
88 Knotty Pine Lane
Property Address �cj
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every .p_
page. City/Town State Zip Code Date of Inspection A,,'s
Inspection results must be submitted on this form. Inspection forms may not be altereil'in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information i5i# 13CQ qc�
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
w Company Address
Sandwich Ma 02563
City/Town State Zip Code
,emu (508)477-0653 S113747
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
Brett Hickey 3-27-19
6eb:201B.OM1.Q]161]:10 Le9O
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18
T ,I
f V
t
f
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
�V
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are
indicated below.
Comments:
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
I
.�
Commonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
L/ 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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
r
Commonwealth of Massachusetts
j� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
V
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well".
Method used to determine distance:
*"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
P 9 9
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:
The septic tank was found to have only 6"of water in it when inspected showing the tank is leaking.The
SAS(leach pit)was found to be dry, but stained over the top row of leaching holes when inspected. Per
Barnstable Board of Health regulations the system"Needs Further Review".
4) 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
❑ O 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
c� Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town 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 orcesspool
❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less
than day flow
❑ 0 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.
❑ Q 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 water supply
well.
❑ 0 Any portion of a cesspool or privy is within 50 feet of a rivate water supplywell.
P
❑ El 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.]
❑ El The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ Q The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
i; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
v�
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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
❑ ED Pumping information was provided by the owner, occupant, or Board of Health
❑ El Were any of the system components pumped out in the previous two weeks?
❑ El Has the system received normal flows in the previous two week period?
❑ O 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)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
0 ❑ 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?
❑ El 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:
❑ El Existing information. For example, a plan at the Board of Health.
El ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
No design plans 3
Number of bedrooms(design): Number of bedrooms(actual):
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): NA
Description:
No design plans on file at Board of Health
Number of current residents: 0
Does residence have a garbage grinder? ❑ Yes 0 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 R1 No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonal use? ❑ Yes 0 No
Water meter readings, if available(last 2 years usage (gpd)): See below
Detail:
2017- 2,000 gallons 2018- 1,000gallons
Sump pump? ❑ Yes M No
Last date of occupancy: 3 weekend ago
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
88 Knotty Pine Lane
V
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
� Type of Establishment: NA
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 es discharges to:
yes, 9
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:
Owner-exact date of last pump is unknown(maybe 2 1/2 years)
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:
I
t5insp.doc•rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 16
cam•, Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
V, Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner)and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
El Other(describe):
Tank and Pit
Approximate age of all components, date installed (if known)and source of information:
unknown due lack of records
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
1'8"
Depth below grade: feet
Material of construction:
❑ cast iron ❑■ 40 PVC ❑other(explain):
Town water
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
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
M 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
8"
Depth below grade: 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
1
Dimensions: 000gallons
"Tank leaking"
Sludge depth:
If if
Distance from top of sludge to bottom of outlet tee or baffle
If If
Scum thickness
It 11
Distance from top of scum to top of outlet tee or baffle
of if
Distance from bottom of scum to bottom of outlet tee or baffle
viewed
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 tank had only 6" of standing water when view.
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
l
Commonwealth of Massachusetts
Title 5 Official Inspection Form
°l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
` cam 88 Knotty Pine Lane
v
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
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: NA
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
I Title 5 Official Inspection Form
f' le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town 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):
NA
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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.):
NA
* 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:
Elleaching pits number: (1 ) 6'X6'
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u—
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching was dry when viewed but had high staining over top row of holes in leach pit.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
layer
Depth of solids la
P Y
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 ondin condition of vegetation,
( 9 Y P 9� 9 ,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
•1
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I°I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
v5V11
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
Materials of construction: NA
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
r
cam° Commonwealth of Massachusetts
ip Title 5 Official Inspection Form
�_ p
I a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
v
Property Address
Edward Gilsenan
Owner Owners Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
A
Al-2F
A2.2W ( 2 J
A3.33' �✓
BI-25'
132-2V
B3.31'
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
I
o
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
St
page. City/Town ate 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: NoGW@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
0 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)
ED Accessed USGS database-explain:
USGS and town topo maps show property is >12' above high ground water
You must describe how you established the high ground water elevation:
Bottom of SAS is >4' above high ground water.
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
88 Knotty Pine Lane
V
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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
4
s`
t5insp.doc•rev.726/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
sob to
TOWN OF BARNSTABLE e'v,f-J4,7' ,9-,—7
LQCATION SEWAGE #
ASSESSOR'S MAP 6z LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
LEACHING FACILITY:(type) Cass /- (size)
NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER '
BUILDER OR OWNER
DATE PERMIT ISSUED: /97D
DATE COMPLIANCE ISSUED:
VARIANCE GRANTED: Yes No
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INSTALLER'S NAME A ADDRESS
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S UILDER R OWNER
DATE PERMIT ISSUED
DATE COMPLIANCE ISSUED
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c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is required for every Centerville Ma 02632 3-27-19
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.
fmngoutf Important: A. Inspector Information
filling out forms
on the computer, Brett Hickey
use only the tab y
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Ito Company Address
Sandwich Ma 02563
City/Town State Zip Code
rx (508)477-0653 S113747
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. 0 Needs Further Evaluation by the Local Approving Authority
4. ❑ Fails
Dr X.1,cIOnW Gy Brett Wtluy
Brett Hickey W.._.1-Y.......m,_o ®�,.de,.�..o...n.—S 3-27-19
le:]O1B 0<.tt110:1�:10-0C'W
Inspector's Signature pe 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
u
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. CityFrown 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:
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
Commonwealth of Massachusetts
Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
u� Property Address
Edvyard Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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
c Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
`F 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. CitylTown 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:
The septic tank was found to have only 6"of water in it when inspected showing the tank is leaking.The
SAS (leach pit)was found to be dry, but stained over the top row of leaching holes when inspected. Per
Barnstable Board of Health regulations the system"Needs Further Review".
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El El clogged
of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 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.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
�^ I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ O Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ O Liquid depth in cesspool is less than 6" below invert or available volume is less
than 'h day flow
❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ Q Any portion of the SAS, cesspool or privy is below high ground water elevation.
❑ O 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 water supply
well.
❑ E Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El 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.]
❑ a The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
❑ 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.
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
l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18
Commonwealth of Massachusetts
,p Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
Y � 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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
❑ El Pumping information was provided by the owner, occupant, or Board of Health
❑ [I Were any of the system components pumped out in the previous two weeks?
❑ 0 Has the system received normal flows in the previous two week period?
❑ O 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
El NA available note as N/A)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
0 ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ O 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:
❑ F] Existing information. For example, a plan at the Board of Health.
Q ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
I
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
is ,lp Title 5 Official Inspection Form
= I?1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
u� Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
No design plans 3
Number of bedrooms (design): Number of bedrooms (actual):
NA
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):
Description:
No design plans on file at Board of Health
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes 0 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 0 No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonal use? ❑ Yes [E No
See below
Water meter readings, if available (last 2 years usage (gpd)):
Detail:
2017- 2,000 gallons 2018- 1,000gallons
Sump pump? ❑ Yes 0 No
3 weekend ago
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
c � Commonwealth of Massachusetts
i= Title 5 Official Inspection Form
1. Subsurface Sewage Disposal System Form Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
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:
Owner-exact date of last pump is unknown(maybe 2 1/2 years)
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
r ,p Title 5 Official Inspection Form
col Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
❑ Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank. Attach a copy of the DEP approval.
0 Other(describe):
Tank and Pit
Approximate age of all components, date installed (if known) and source of information:
unknown due lack of records
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
11811
Depth below grade: feet
Material of construction:
❑ cast iron ❑■ 40 PVC ❑ other(explain):
Town water
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
c � Commonwealth of Massachusetts
�= l Title 5 Official Inspection Form
I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
"F � 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank (locate on site plan):
8"
Depth below grade: 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
1
Dimensions: 000gallons
"Tank leaking"
Sludge depth:
n n
Distance from top of sludge to bottom of outlet tee or baffle
r� rr
Scum thickness
n n
Distance from top of scum to top of outlet tee or baffle
11 "
Distance from bottom of scum to bottom of outlet tee or baffle
viewed
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 tank had only 6" of standing water when view.
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
'= 1� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap (locate on site plan):
NA
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):
NA
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
cam, Commonwealth of Massachusetts
�n ,p Title 5 Official Inspection Form
�= �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
v�
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town 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 co of current pumping contract(required). Is co attached? Yes N
copy p p 9 copy ❑ ❑ o
9. Distribution Box(if present must be opened) (locate on site plan):
Depth of liquid level above outlet invert NA
Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
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` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
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.):
NA
* 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:
(1 ) 6'X6'
leaching pits number:
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
l5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
IR j1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
Leaching was dry when viewed but had high staining over top row of holes in leach pit.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
Number and configuration NA
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.7/26/2016 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
f
cry Commonwealth of Massachusetts
Title 5 Official Inspection Form
l'.l Subsurface Sewage Disposal System Form Not for Voluntary Assessments
88 Knotty Pine Lane
v
Property Address
Edward Gilsenan
Owner Owner's Name
information is required for every Centerville Ma 02632 3-27-19
page. Cityrrown State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy (locate on site plan):
NA
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
i -
Commonwealth of Massachusetts
Title 5 Official Inspection Form
'= I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
..�/� 88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is required for every Centerville Ma 02632 3-27-19
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑ hand-sketch in the area below
❑ drawing attached separately
A B
Al-26'
A2.29'
A3.33'
B9.25'
B2.28'
B3.39'
0
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18
cam, Commonwealth of Massachusetts
�_ Title 5 Official Inspection Form
ii. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville Ma 02632 3-27-19
required for every
page. CityFFown 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: No GW @ 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
0 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:
USGS and town topo maps show property is >12' above high ground water
You must describe how you established the high ground water elevation:
Bottom of SAS is >4' above high ground water.
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
�= 1,` Subsurface Sewage Disposal System Form - Not for Voluntary Assessments
88 Knotty Pine Lane
Property Address
Edward Gilsenan
Owner Owner's Name
information is Centerville J Ma 02632 3-27-19
required for every
page. CityTTown 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 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
TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services
BROUGHT TO WITHIN 6"OF (not to'scale)
- EL. 60.0' EL. 58.0' FINAL GRADE INSP. PORT W I 3" OF GRADE
U CLEAN SAND P.O. Box 331
2"of e"to z" DOUBLE WASHED PROP. EL. 58.0' Hanvkh, MA 02645
4"CAST IRON or EQUIVALENT PEASTON5-OR GEOTEXTILE
MIN. PITCH 1/4" PER FOOT FILTER FABRIC 774.994.1166
a"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE .
FLOW LINE flfstZ b be/even VENT IF REQUIRED
5' 2.8%
•.�' ' L.EXIST.
14 ~� o0 00
o0000e
EL EXIS 0000000000 0 0000o0o0c
EL55.6' 000 000 00 .
EL 54.73, 000°0° 00000000 ® ® 00000000c
0 0 00000 °oo° Ooo° e2.0
1.54.9' 000000 ®� 0000 '
GAS BAFFLE EL 54.7' 0°0°0°0°00°00°0°0 ® N Q��� 0°0°0°0°c_
0 0 0 0
'...�. 000000000° 000000 . �4' • A . 00000000c EL.52.7'
(H 2O o-BOX) '
•3:'' `:'; 6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM
1000 GALLON SEPTIC TANK MECHANICALLY COMPACrEo (2) 500 GALLON H-20 CHAMBERS
(DATUM: ASSUMED) EXISTING WITH 4'STONE AROUND IN A 5.2'
�" to 1 " DOUBLE WASHED STONE 12.83'X 25'X 2'CONFIGURATION
BOTTOM OF TEST HOLE EL. 47.5' EL. 47,5'
USGS ADJUSTMENT: N/A LOCAT/ONMAP
/ ANO1-7y BENCHMARK: GROUNDWATER ELEV: N/A
�IN` 4fy
C/ ��� EL. 0.0 NDN IVTH
'
IS0,00' LOCUS
Menemshe Ln.
> >
DRIVEWAY EXISTING
3 BR NTS
yi Or
GSLAB) DWELLING
DA !D G
F J R.
LOT 31
I 0.44 ACRESf 21
7 4'
MAP 191 PLOT 100 O EXIST. S.T. 18TER``®
CA 411TA
i
OATS'5/712019 REV/SED.
180,00'
N
14,3' SITE AND SEWAGE PLAN FOR
B& B EXCAVATION,INC./
EDWARD GILSENAN
88 KNOTTY PINE LANE
(CENTERMLE) BARNSTABLE,
SCALE: 1" = 30' MA
REP LCP 32aga-B SH I PAGE i OF2
..................................................................................................................... .................................. ............................. ................................................................. ................................ ................... ...................................................................... ......................................................................................................................................................................................................................................................................................................................................
GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services
P. 0. Box 331
I. ALL PRECAST COMPONENTS TO BE H-10
Harwich, MA 02645
RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 3 774.994.1166
DISTRIBUTION BOX(ES)AND ANY
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
(110GAL/BRIDAYX3BR) 330 GAL.1VAYq
ALLOW FOR THE USE OF A GARBAGE
GRINDER.
REQUIRED SEPTIC TANK CAPACITY 660 GAL,
3. MUNICIPAL WATER IS AVAILABLE.
25'
4. ALL CONSTRUCTION TO CONFORM WITH SIZE OF SEPTIC TANK 1000 GAL.(EXISTING)
310 CMR 15.000 AND ALL OTHER
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION
CODES AND REGULA TIONS.
5. INSTALLER/CONTRACTOR TO REVIEW& DESIGN PER TION RA TE <2 MINAINCH'
VERIFYALL ELEVATIONS AND DETAILS
EFFLUENTLOADING RATE a 74 GAL.IDA YIF T2
AND REPORT ANY DISCREPANCIES TO
33'
DESIGNER PRIOR TO CONSTRUCTION OR
ASSUME ALL RESPONSIBILITY, LEACHING AREA
(2)x(25.0'+ 12.83)(2) = 151SF
6. INSTALLER/CONTRACTOR IS 25.0'x 12.83' =320 SF
RESPONSIBLE FOR MAINTAINING SAFE 471 SFx a 74 =348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12-83'X25'CONFIGURATION ASDIAGRAMMED
CONSTRUCTION.
7. ANY CHANGES TO OR DEVIATIONS FROM
RESERVE LEACHING CAPACITY NIA GPD
THIS PLAN MUST BE APPROVED IN
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS)
UNLESS SHOWN PER PLAN.
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVA L UA TION
FILLED WITH CLEAN SAND OR REMOVED
TESTHOLE#1 F#19-16 TESTHOLE#2 P#19-16
OF bq
AND REPLACED WITH CLEAN SAND. Evaluator. David D.Flaherty Jr.,RS,REHS Evaluator. David D.Flaherty Jr.,RS,REHS YIN,
10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755
WITH WATERTIGHT ACCESS PORTS BOH Witness: David Stanton,RS BOHWWb7a=. David Stanton,RS
Date, May2,tors
Date: May2,2019
WITHIN 6"OF FINISH GRADE. F R
in
I 1.ALL SEPTIC TANKS, DISTRIBUTION
TH-I ELEV.56.0' TH-2ELEV 58.0' 2
BOXES AND PIPING TO BE INSTALLED
WATERTIGHT. 0'-98" A SL 10YR&2 0'-96" A SL 10YR&2 IST
12.NO KNOWN WETLANDS OR WELLS 9.-,W. 6 SL 10YR 516 IVIT R%
9'-40" B SL 10YR 516
WITHIN 100 FEET OF PROPOSED
LEACHING.
13.THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
(W-) Pem 7 certify that on November 12,2002,fhavepassed
F/ SITE AND SEWAGE PLAN
PLAN TO BE USED FOR ZONING OR
the examination approved by the Department of
BUILDING PURPOSES. Environmental Protection and that the above analysts FOR
14.LOT IS SHOWN AS ASSESSOR'S MAP 191 has been performed by me consistent*0 the
8 Bic EXCAVATION, INC./
40"-126' C CMS 2.5Y 614 40"-120' C CMS 2.5Y614
required fairing,expertise and experience described
LOT 100. 5 gravel
5%gravel In 310 CMR 15.018(2). EDWARD GILSENAN
15,LOCUS PROPERTY IS NOT LOCATED
WITHIN AN AQUIFER PROTECTION 88 KNOTTY PINE LANE
DISTRICT(ZONE II). G.W.ELEV.NIA G.W.ELELEV.NIA (CENTERVILLE)
BOTTOM TH-1ELEV 47.5'1 BOTTOM TH-2 ELEV. 48.0' BARNSTABLE, MA
PAGE20F2
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