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HomeMy WebLinkAbout0083 LAKE DRIVE - Health 83 Lake Drive Centerville A= 230—084 1, l i i Lo � $3 L ACE V � c�4N rc VJL l4,'7-1'r"A G wo �L,S >N7Z--7Z-10 q W PLLS ax� 3��d AC7"AL io /A% a A 5 uJ/�us s� -V4S a LA Tl o,^O i3 o p T 7 ��1292104 LOG bo r1&,C GZ,}5S ShTS a S 0 D 0 vhpo& bA f BIZ (� i P�AST� G A R s F S SMOKE DETECTORS REVIEWED Ly 6 A TA BUILDING DEPT. DATE cA VES FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED FOR PERMITTING cav :a �s C7 GN u � up o LA `N 1? _,;z, " s a -74 r { a � � V 1 . ' Commonwealth of Massachusetts wgo— Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments „ M 83 Lake Drive Property Address Blair Taylor Owner O t wner's Name information is required for every Centerville MA 02632 6-19-17 ra page. Cltylrown State Zip Code Date of Inspection r0 Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms ����uIIrllrnq� use only the ton the ab �� l��l� \` `�.'�HOFIIggs��4�ii k�;.••...... 1. Inspector: .ya sq �% key to move your �_:• C' �� cursor-do not James D use the return .Sears JA M ES •,R, key. Name of Inspector 0; Ca ewide Enterprises Company Name . .. TIF �. 153 Commercial Street ''o, 5 ►NSP�; Company Address Mashpee MA 02649 Citylrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. 1 am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6-24-17 nspector'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 should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 /W Vs Commonwealth of Massachusetts 4 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments •�' 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. Cltyrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system is a 1500/500,Gal. two compartment H-20 tank w/air blower, D Box and three chambers. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 ' Commonwealth of Massachusetts u a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is Centerville required for every MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment.. I. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts H - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in is less than 6" below invert or available volume is less than Y2 day flow I-Fll e-HIly& t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form R Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w •''y� 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate 'regional office of the Department. t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available:note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts -W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is Centerville required for every MA 02632 6-19-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500/500 Gal. two champartment. H-20 tank w/air blower, D Box and three chamber's. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage(gpd)): 2015-7,000Gal's Detail: 2016-15,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single 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): Pump Chamber t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is Centerville required for every MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2007 Permit #2007 -577 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2' feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH -40. Septic Tank(locate on site plan): Depth below grade: 1' 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: 1500/500 Gal. Precast H-20 Sludge depth: 1" t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is required for every Centerville MA 02632 6-19-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17" How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level w/three steel covers at 2". 1500 Gal. Septic w/500 Gal. Pump chamber clean w/one pump. No sign in tank of over loading. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top Of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwe alth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is required for every Centerville MA 02632 6-19-17 page. Cltyfrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts w W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. Cltylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x1T-6" below grade. Box is clean and solid w/no sign of over loading or solid carry over. Two line's out. 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.): Pump chamber clean w/no sign of solid carry over. One pump Pump and alarm working * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts u Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is three chambers(11'x23') . Chamber's are 17" below grade. Clean and dry w/clean wall's like new. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is required for eve ryCentervill e MA 026 -32 6 19-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately r � i -r ° D} l 4� 0 vi 13`y_ I t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owners Name information is required for every Centerville MA 02632 6-19-17 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to tground water: 9 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: 8-8-07 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: T.H. on Design plan 8-8-07 9' G.W.. Bottom of chambers at 2'-6" below grade. Bottom of chamber's at 6-6"above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Blair Taylor Owner Owner's Name information is required for every Centerville MA 02632 6-19-17 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal 0•S stem Page 17 f Y 9 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the S;f a� computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name r� P.O.Box 763 Company Address Centerville Ma. 02632 �rmn City/Town State Zip Code 5( 08)428-4028 _ S14454 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 6/5/2009 Inspec or's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. - 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based-on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1500/500 gallon two compartment tank with Aquaworks Remediator,pump,distribution box and three LC6 chambers. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d NA 9 ( Y 9 (gP ))� Detail: Sump pump? ® Yes ❑ No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single 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): System has a Aquaworks Remediator t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: System installed 1/15/2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10'+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the leaching. 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: 1500/500 two compartment Sludge depth: 0 t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 34" Scum thickness 0 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c,M ,•''V 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No i t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 'M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.):. Pump Chamber(locate on site plan): Pumps in working order: N Yes ❑ No Alarms in working order: ® Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump chamber,pump and alarm in good condition. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 f Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3-LC6 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Sandy Dry soil.No signs of hydraulic failure.System has seen very little use since installed. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below drawing attached separately gi C201, r 50 I��� ►3 15� 60 a� t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 f Commonwealth of Massachusetts L W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town . State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leaching 3' 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 007 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-0001 plate#2 annual ranges of groundwater elevations. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 r c Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 83 Lake Drive Property Address Estate of Janice Pattberg Owner Owner's Name information is required for Centerville Ma. 02632 6/5/2009 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary:A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems)completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION Q la k(s SEWAGE# 7001 5-7-7 VILLAGE ASSESSOR'S MAP&PARCEL �� C` INSTALLERS NAME&PHONE NO. n1 SEPTIC TANK CAPACITY I S © rj 0 0 CID MR LEACHING FACILITY:(type) '25 CC(1> (size) 11 � X a3 NO.OF BEDROOMS 5n, OWNER PAtC ,d� PERMIT DATE: ,2.-►et — Z,eoo-7. 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 C4D4n.J�`� � VrQn ALL i �� qv5� �a, �9 ' 00 3 50 -AS Ij 5 'ZQ" AG A�x ��P IOjO > O A7 �s�b` 97 au. �� A q oa 1141(0 Fee THE COMM NWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DVVISIdN - TOWN OF BARNSTABLE, MASSACHUSETTS Yes applicatton for Migozal *p5tem con0tructton vermtt Application for a Permit to Construct( ) Repair(vf Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. (,,4 i';�� C.e„,�.�k(C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel 'L 3 6/6 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. L- Enbr 2e4,1 I-L P.O. '3 ax z e 3 2FSy C rgd,(,eev7 I �,y C ,,Fe•w�l-f- V"w m'.3I- /e I" Type of Building: Dwelling No.of Bedrooms Lot Size t ,l 7 sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 2-3 04 gpd Plan Date �-'L,(-Z ---� Number of sheets Z Revision Date Title Z43 e-%4kt.-,Vc.f�& Size of Septic Tank i 50 Type of S.A.S. CC-C= (t���►.Li: S Description of Soil SZ-A-- 421 t4a.L C', 5 -7 Yj ` 0 i Nature of Repairs or Alterations(Answer when applicable) 0" 15_8�0 4 A,' —2,ca 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'gned Date [ 1-3 0 20 7 Application Approved by a� Date Application Disapproved by: Date for the following reasons Permit No. 2_57 Date Issued C/- t 1 P r . o `f✓�■.�r�'.�'� �J) �? ....._ ._, i� Fee ^+ THE COMM NWEALTH!OF MASSACHUSETTS ' "`Entered in computer: yam , PUBLIC`HEALTH D� SION - TOWN OF BARNSTABLE,,MASSACHUSETTS Yes Application for hermit , Application for a Permit to Construct O Repair Upgrade O Abandon O ❑.Complete System ❑Individual Components Location Address or Lot No. `� (, (.� ix p,.,�..1�� Owner's Name,Address,and Tel.No. $s t..wL... �c�M Assessor's.Map/Pazcel 2 3 p/��I }` Ct e.�bv; '[!c Iff rl 621;L Installer's Name,Address,and Tel.No. ._u Designer's Name,Address and Tel.No. T.L' 00. 30x 7,.3 L(Av,lur- L 0-I w o26; Fe f(e M •1,q r Zr Tyke olf Building: Dlelling No.of Bedrooms Lot Size 1`�, 7 i sq.ft. Garbage Grinder ( ) Other ; Type of Building 5 No.of Persons Showers( ) Cafeteria( ) Other Fixtures k Design Flow(min.required) 'Z2,0 gpd Design flow provided 2-3 O. k gpd Plan Date --LAB -Z.oa"') Number of sheets Z" Revision Date Title �3 f�}�.e /> Size of Septic Tank 1600 Type of S.A.S. 3� („L� t't•,p«r.(�e�c, Description of Soil SA-0- D WA,, C 7y� i Nature of Repairs or Alterations(Answer when applicable) I j of c,A y 1{"2U jr,44 I- Date last inspected: z ?i Agreement: / The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system ifi r accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. k S'gned Date Application Approved by Date f Application Disapproved by: Date for the following reasons r" Permit No. r �""J Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance 1 THIS IS TO CERTIFY,that the On-site +Sewage Disposal System Constructed ( ) Repaired (X Upgraded Abandoned( by at 83 L �( v-e. has been constructed in accordance 1 with the provisions of Title 5 and the f r Disposal System Construction Permit No. c �"5� dated � a� fld� Installer �--�p�t.�J.t Qf t sC'S Designer ; IL bedrooms#bedrooms Approved design flow { gpd The issuance o t .s peril shall not be construed as a guarantee that the system V f�u ct'70as, )esii ed! b Date Inspector � :/ ----------_-------------------- ----- y No. �)� / Fee THE COMMONWEALTH OF MASS ;�SSACHUSETTS TTS PUBLIC HEALTH DIVISION-BARNSTABLE wi.gpoal *p$tem Con5trUctiori Permit Permission is hereby granted to Construct ( ) Repair ( Vj Upgrade ( ) Abandon ( ) System located at and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. _ Provided: Construction must be completed within three years of the date of this'permit Date ` f--}�,/! 1 I Approved by Janice L. Pattberg 83 Lake Drive Centerville, MA 02632 , l September 26, 2007 Board of Health Town of Barnstable 200 Main Street Hyannis, IVIA 02601 Re: Declaration of Authorization Dear Members of the Board: Let it be known that I, Janice L. Pattberg;do hereby authorize JC Engineering, Inc. of East Wareham, MA 02538 to represent my interest regarding the upgrade of the sewage disposal system located at 83 Lake Drive, Centerville, MA in meetings both public and private. Sincerely, i Janic L. Pattberg —U L». ^5 CD [` C:\DOCUME—I\RICH-1.CAPUACALS-1\Temp\Authorization Lettecdoc R '}�} �(c y � l our Points 0 9�;-39 Sheraton 'ell 1 � Q - i Four Points by Sheraton Hyannis Resort 35 Scudder Avenue,Hyannis,MA 02601 Tel: (508) 7t-7775 Fax:(508)778-6423 fourpoints.com/hyannis I } _ 1 own rat i3arnstabie Regulatory Services Thotnaas f.Geiler,Director BARN AMS, MAIM, t'ublic :Health Division _ Thomas,McKean, Director a00 Main Street,F(yanni's,MA 026011 Office- 508-862.4G44 Fax: 508.790 6304. Installer & Destg{n-er Ggrtification Forrmt Date: Desiver: .0__fin rn r.�(r } t V) _ Installer; _ '+'Wvi cle Address yCc ►1verty��'• '` �. .,�. Address, 3'1- Qn a-l�j_-T 2L 7 _ T 1 rl S was issued a permit to install a ate;) (installer) septic sySWITI at _ 6 3�.._1,n Ke~ D c•j V based on a design drawn by - <1'dress) 5c��tY.�lner Zy 44Jv7; t� ,�tewrt�lcv�G __ dated tow 1.: (dce�i fir) _ V t 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 distribution box and/or septic tank, I certify that the septic system referenced above was installed with mayor changes (i,e, greater than 10' lateral relocation of the SAS or any vertical.relocation of any component of the septic systern) but in accordance with State & Local Regulations, Flan revision or certified as-built by designer to follow, S11 DF �W. CWURCHIL.LR. ' is teller's Sign ire) Civil 41.807 ST r'�• / pesignor's!S' ature) s Stamp Here) PLEASE RETU.01 TO.,BARNSTAS E PUBLIC H AV Egi2 ON. CERTIFICATE OF C. MP 'I CEILL N S UNTIL H AS- B I A REC V BY:T S 'AIX.IE 'Vi Xt)N, THANK YU'tJ• Q: Health/Septic/DcsiOer Certification Form 1 0 'd 4920 2:L7- 80S JNId33NI:JN3:3f WV 6S: 60 800Z-84-Nt�lC a s , ` u u u DEED RESTRICTION WHEREAS, _ Li\lce.L eATrb._.,r of (owner's name) B 3 L CXA-.rE2j;I l e MA (address) is the owner of S 3 4-41" located at t. CzV fi rL\j ►%\C (address) r MA (hereinafter referred to as �3 L 4 1Q and ,0eing shown on a plan entitled "Subdivision of Land in MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book,c( ( l , Page Or on Land Court Plan Number WHEREAS, ~S�n�c_.e L P�rrt�<,,rr as the owner of said lot has (owner's name) agreed with the Town of Barnstable Boar4 of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum .Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, deedr r l.• NOW, THEREFORE, �� _ rt does hereby place the (owner's name)U following restriction on his above-referenced land in accordance with dais r. agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: v may have constructed (address) upon the lot a house containing no more than' rwo '(L)bedrooms. U, . PA-It b4.w-4 agrees that this shall be permanent deed Ilowner's name S �I' e-3 10 r restriction affecting V 12. located on e,��r-v 11-e. _ MA, and being shown on the plan recorded in Plan Book i z z , Paged I?g Or on Land Court Plan For title of see the following deed: Book '3�. ( Page . Or Land Court Certificate of Title Number Executed as a sealed instrument 3p day of N'vf—�e f_ a-00--) Own is signature 3arj cc Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS ss r\(Ju 20ol Then personally p peargd the above-named a z P c c,4 6,e ✓'�,, known to me to be the person whiVexecuted the foregoing instrument and acknowledged the same to be �,� r free act and deed,before me, 3-t.ac� .LM IMACCARONE COMMONWEALTH OF MASSACHUSETTS Notary Public My COMM19410n Expires June 30.2009 My commission expires: (date) deedr �G `^ (L°� _ 4 06/02/2009 11:41 FAX 5084283928 CAPEWIDE 9 001/002 V. J.P. Macomber&Sons Post Office Box 763 Centerville,MA 02632 INSPECTION AND EFFLUENT TESTING AGREEMENT Agreement entered into by and between Capewide Enterprises,LLC and Aquaworx OWNER(herein called OWNER)for the inspection by.Capewide of certain equipment of OWNER which is described below. Upon acceptance of this agreement at Capewide's office,Capewide will render the following services only: Equipment will be inspected at least 4 times per year that this Agreement remains in effect,with the first inspections beginning Ao;� r 6, Zaxig These inspections will include: 1) Testing of the sludge depth in the septic tank. 2) Check effluent temperature and level. 3) Inspect over-all condition of Aquaworx System. 4) Notify OWNER of any problems encountered. 5) Invoicing on a quarterly basis for testing only to be paid within 30 days from the date of invoice. Annual maintenance cost to be paid in full upon acceptance of this agreement. 6) Must receive a signed purchase order from OWNER prior to any work being performed other than that covered by this Inspection Agreement. Service other than routine maintenance will be billed at an hourly rate plus travel and material. Capewide shall notify the local Board of Health and Department of Environmental Protection in writing within 24 hours of a system failure or alarm event including corrective measures that have been taken. OWNER will be billed standard Capewide charges for any parts used in repairs or maintenance.Any additional labor time will be billed to the OWNER at current labor rates of$75.00 per hour. Emergency service between regular inspections will be provided at standard labor rates during normal business hours;at time and one-half after 5:00 PM and on Saturdays; and at double time on Sundays and holidays. Emergency service charges will include a minimum four(4)hours of labor,plus standard Capewide charges for parts, plus mileage and travel charges.The annual rate includes routine maintenance,but does not include repairs required for damages caused by abuse,accident,theft,acts of third persons,forces of nature or alterations made to the equipment.Capewide shall not be responsible for failure to render the agreed services if caused by strikes, labor disputes,non-cooperation by.OWNER or other factors beyond the control of Capewide. OWNER understands and agrees that Capewide is not responsible for special,incidental or consequential damages,including but not limited to loss of time,injury to person or property or equipment failure. OWNER agrees that Capewide may enter OWNER's property and have acceptable access to all areas deemed by Capewide to be necessary or appropriate for Capewide to perform its duties hereunder. 06/02/2009 11:41 FAX 5084283928 CAPEWIDE 0 002/002 Current Capewide practice into send OWNER approximately 10 days before expiration of the term of the current contract(1)either a new contract of an offer to extend the current contract's term,and(2)an.invoice for one year of service.It is OWNER's responsibility to timely return the payment and either the new contract or the acceptance extension,completed and signed. Capewide must receive the payment and document before expiration of the then current contract year to assure continuous contract coverage.Failure to return such documents on time or to otherwise comply with this contract may result in suspension of service,cancellation of the contract and/or nullification of warranties at the election of Capewide. OWNER may not assign this contract without the prior written consent of Capewide.It will remain in force until a party cancels by written notice to the other at the address given herein or until the contract term expires,whichever is sooner. MANUFACTURER MODEL NO LOCATION ANNUAL RATE Infiltrator Aquaworx Centerville,MA $1,000.00 EQUIPMENT OWNER Capewide Enterprises,LLC *Signed by OWNER: A Signed: Post Office Wox 763 *Address: Centerville,MA 02632 Phone: 508428-4028 *City: Fax: 508428-3928 *Telephone: Effective Date of Agreement: L— o I-ZQoS, OWNER understands that(1)ANNUAL RATE payment is for one year only commencing on the effective date set forth above and is non-refundable; and(2)Current DEP Regulations require OWNER to maintain a service agreement for the life of the Aquaworx System.I HAVE READ AND UNDERSTAND THE FOREGOING. *Signed by OWNER Effluent Testine Effluent testing taken 4 times per year and delivered to a qualified testing lab for evaluation.Results sent to State and local Agencies as well as the OWNER.OWNER is responsible for providing acceptable access to effluent to enable a grab sample to be.taken for laboratory testing performed. PEIUWr *PLEASE CHECK ONE ( )GENERAL ( )REMEDIAL { )PROVISIONAL *SPECIAL CONDITIONS PER LOCAL BOARD OF HEALTH(Y)or(N)if YES,please attach a copy of permit. (x)pH,BODs,TSS,Nitrate,Nitrite,TKN ( )Other: *Cost for testing: $250.00/visit Operator assigned: Telephone: *Engineer: *Approval for Effluent Testing Owner's Signature TOWN OF BARNSTABLE Health Division - 200 Main Street - Hyannis, MA 02601 0p IHE to AXDate: . + BARNSTABLE, 9a 1639 Number of pages • cluding cover sheet: DATED MAC A, To j From: SHARON CROCKER 1 � �� Town of Barnstable 00 Health Division Mail to: 200 Main Street Phone: Hyannis, MA 02601 Fax phone: Phone: 508-862-4644 CC: Fax phone: 508-790-6304 REMARKS: ❑ Urgent ❑ For your review ❑ Reply ASAP ❑ Please comment Oj F'3 � C� U9COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET, BOSTON, MA 02108 617-292-5500 DEVAL L.PATRICK Governor . , , _ _ IAN$ A.BOWLES Secretary TIMOTHY P.MURRAY Lieutenant Governor ARLEEN O'DONNELL Commissioner . �2�`vedrao r►�-.~_ dee:���nes�rC c�.oY�-- •}� MODIFIED APPROVAL FOR REMEDIAL USE Pursuant to Title, 310 CMR 15.000 Name and Address of Applicant: CLn Z M lk.lil(7 (0066 Aquaworx, a Division of Infiltrator Systems Inc. 6 Business Park Road P.O. Box 768 Old Saybrook, CT 06475 Trade name of technology: AquaworxTM RemediatorTM Alternative Treatment System (hereinafter called the "System"). Schematic drawings of a typical System and technology checklist are attached and are a part of this Approval. Transmittal Number: W031991 Date of Issuance: May 26, 2004, Modified April 10, 2007, August 2, 2007, Modified August 21, 2007 Expiration date: May 26, 2009 Authority for Issuance Pursuant to Title 5 of the State Environmental Code, 310 CMR 15.000, the Department of Environmental Protection hereby issues this Approval for Remedial Use to: Aquaworx, a Division of Infiltrator Systems Inc., 6 Business Park Road, P.O. Box 768, Old Saybrook, CT 06475 (hereinafter"the Company"), approving the System described herein for Remedial Use in the Commonwealth of Massachusetts. Sale and use of the System are conditioned on compliance by the Company and the System owner with the terms and conditions set forth below. Any noncompliance with the terms or conditions of this Approval constitutes a violation of 310 CMR 15.000. August 21, 2007 Glenn Haas, Acting Assistant Commissioner Date Bureau of Resource Protection This information is available in alternate format.Call Donald M.Gomes,ADA Coordinator at 617-556-1057.TDD Service-1-800-298-2207. MassDEP on the World Wide Web: http://www.mass.gov/dep Co Printed on Recycled Paper Mnditied Approval-for Remedial Use AquaworxTM RemediatorTM Alternative Treatment System Page 2 of 11 I. Purpose l. The purpose of this approval is to allow use of the System in Massachusetts, on a Remedial Use basis to repair systems failing to protect public health and safety and the environment where failure has occurred as described in 310 CMR 15.303 (1) (a) (1) and (2) due to clogging of the soil absorption system (SAS). 2. With the necessary permits and approvals required by 310 CMR 15.000, this Approval for Remedial Use authorizes the use and installation of the System in Massachusetts. 3: The System may only be installed on facilities that meet the criteria of 310 CMR 15.284(2). 4. This Approval for Remedial Use authorizes the use of the System where the local approving authority finds that the System is for upgrade of a failed, failing or nonconforming system and the design flow for the facility is less than 2,000 gallons per day(GPD). 5. This approval is limited to the applicant's use of the technology. MassDEP makes no determination concerning any ownership interest or any other property or legal rights associated with the use of the technology. 11. Design Standards 1. The System consists of an aeration device,40 watt unit operated on a continuous basis, and a System bacterial source installed in an existing septic tank or a new septic tank designed in accordance with 310 CMR 15.223 through 15.228. The bacterial source consists of plastic media coated with the bacteria. The System converts the septic tank into a facultative bioreactor to treat residential strength wastewater from facilities with a design flow of less than 2,000 GPD. The treated effluent is discharged to either the existing soil absorption system or to a new SAS designed and installed in accordance with 310 CMR 15.000. 2. A microbial culture is established in the septic tank and maintained using the aeration device and the bacterial source. The aerator mixes the contents of the septic tank with the bacteria and aerates the liquid. The System's biomass reduces both the biochemical oxygen demand (BOD5) and the total suspended solids(TSS)concentration in the effluent from the septic tank. The effluent from the septic tank contains dissolved oxygen and System bacteria that Yg Y at discharge to the SAS and act to reduce the thickness of the biomat improving the soil absorption capacity. 3. Prior to installation of the System, the site shall be evaluated in accordance with 310 CMR 15.100 through 15.107. The existing on-site system including the septic tank, distribution box and SAS shall be inspected in accordance with 310 CMR 15.302. M,Wified Approval for Remddial Use f AquaworXTm RemediatorTM Alternative Treatment System Page 3 of 1 l 4. A System shall not be proposed for installation where: A. The high groundwater elevation determined in accordance with 310 CMR 15.103 would be less than two feet below the bottom of the SAS. B. A facility for which the site investigation indicates that the existing onsite system was designed and installed for a design flow smaller than required by 310 CMR 15.203, unless the onsite system is expanded to meet the current design flow requirements of Title 5. The minimum area for the existing or upgraded SAS shall not be less than 50 percent of the area required in accordance with 310 CMR 15.242. C. An existing septic tank has not been tested and shown to be watertight. D. The proposed installation is for a failed or failing leaching pit or cesspool. E. A site investigation indicates that the existing soil absorption system must be removed and replaced prior to installation of the System. 5 The System shall beequipped with a monitoring device that provides data collection o include tracking the elevation of the effluent in the SAS and temperature. bep ture. The data can stored and reported to include high, low and average leve ss-for-each parameter each mont Farad daily values for the last thirty 6. For seasonal use, the System shall be reactivated by the addition of a fresh culture of bacteria at each start up. III. Allowable Soil Absorption System Design 1. Reduction of the Required Soil Absorption System Size - An applicant is eligible for up to a 50 percent reduction in the area of the soil absorption system required by 310 CMR 15.242, where all of the following conditions are met. Accordingly, in approving design and installation of the System by a particular Applicant, the local approving authority may allow up to a 50 percent reduction in the area of the soil absorption system required by 310 CMR 15.242, provided that all of the following conditions are met: A. No reduction in the required separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the stone underlying the SAS and the high groundwater elevation is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. B. No reduction in the required four feet of naturally occurring pervious material is allowed unless the Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. Any such reduction must first be approved by the local Modified Approval for Remedial Use AquaworxTm RemediatorTM Alternative Treatment System Page 4 of l 1 approving authority and then approved by the Department pursuant to 310 CMR 15.284. C. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (e), (0, and (g)• D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. 2. Reduction of the Required Separation Distance to High Groundwater Elevation - An Applicant is eligible for a reduction in separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) ) between the bottom of the stone underlying the SAS and the high groundwater elevation, where all of the following conditions are met. Accordingly, in approving design and installation of the System by a particular Applicant, the local approving authority may allow a reduction in the required separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the stone underlying the SAS and the high groundwater elevation, provided that all of the following conditions are met: A. A minimum two foot separation (in soils with a recorded percolation rate of more than two minutes per inch) or a minimum three foot separation (in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the stone underlying the SAS and the high groundwater elevation is maintained. B. No reduction in the required SAS size is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. C. No reduction in the required four feet of naturally occurring pervious material is allowed unless the Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. Any such reduction must first be approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (e), (f) and (g). Modified Approval for Remedial Use AquaworxTm Remediatorrm Alternative Treatment System Page 5 of 11 E. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. 3. Reduction of the Requirement for Four Feet of Naturally Occurring Pervious Material —An Applicant is eligible for a reduction in the required four feet of naturally occurring pervious material in an area of no less than two feet of naturally occurring pervious material, where all of the following conditions are met. Accordingly, in approving design and installation of the System by a particular Applicant, the local approving authority may allow a reduction in the required four feet of naturally occurring pervious material in an area with no less than two feet of naturally occurring pervious material, provided that all of the following conditions are met: A. The Applicant has demonstrated that the four foot requirement cannot be met anywhere on the site. No reduction in the required SAS size is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. B. No reduction in the required separation (four feet in soils with a recorded percolation rate of more than two minutes per inch or five feet in soils with a recorded percolation rate of two minutes or less per inch) between the bottom of the stone underlying the SAS and the high groundwater elevation is allowed unless such a reduction is first approved by the local approving authority and then approved by the Department pursuant to 310 CMR 15.284. C. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, the local approving authority may allow a reduction under a local upgrade approval in accordance with 310 CMR 15.405 (1) (a), (b), (e), (f) and(g). D. Where full compliance with all of the minimum set back distances in 310 CMR 15.211 is not feasible, even taking into account provisions for local upgrade approval as described above, then pursuant to 310 CMR 15.410, the applicant first must obtain variance(s) from the local approving authority and then approval of the Department. IV. General Conditions 1. All provisions of 310 CMR 15.000 are applicable to the use of this System, t y , he System owner and the Company, except those that specifically have been varied by the terms of this Approval. Nfedified Approval'for Remedial Use AquaworxTm RemediatorTM Alternative Treatment System Page 6 of 11 2. Any required sample analysis shall be conducted by an independent U.S. EPA or DEP approved testing laboratory, or a DEP approved independent university laboratory. It shall be a violation of this Approval to falsify any data collected pursuant to an approved testing plan, to omit any required data or to fail to submit any report required by such plan. 3. The facility served by the System and the System itself shall be open to inspection and sampling by the Department and the local approving authority at all reasonable times. 4. In accordance with applicable law, the Department and the local approving authority may require the owner of the System to cease operation of the system and/or to take any other action as it deems necessary to protect public health, safety, welfare and the environment. 5. The Department has not determined that the performance of the System will provide a level of protection to public health and safety and the environment that is at least equivalent to that of a sewer system. No System shall be installed, upgraded or expanded, if it is feasible to connect the facility to a sanitary sewer, unless as allowed by 310 CMR 15.004. When a sanitary sewer connection becomes feasible, the facility served by the System shall be connected to the sewer, within 60 days of such feasibility, and the System shall be abandoned in compliance with 310 CMR 15.354, unless a later time is allowed, in writing,by the approving authority. 6. Design, installation and operation shall be in strict conformance with the Company's DEP approved plans and specifications, 310 CMR 15.000 and this Approval. E.7 Conditions Applicable to the System Owner 1. The System is approved for use with sanitary sewage only. Any wastes that are non- sanitary sewage generated or used at the facility served by the System shall not be introduced into the System and shall be lawfully disposed. 2. Any effluent samples shall be taken at the distribution box or the pipe entering a pump chamber or other Department approved location from the treatment unit. Any required influent sample shall be taken at a point that will provide a representative sample of the influent. Influent sampling locations shall be upstream of the septic tank at a location determined by the system designer, subject to written approval by the Department �Operationand-Maintenance Agreement: A. Throughout its life, the System owner shall operate and maintain the System in accordance with the Company and designer's operation and maintenance requirements and this Approval. To ensure proper-operation-and maintenanc (O&M),tthe System owner shall enter into an O&M agreement. No O&M agreement? shall be for less than one ye ra Mddified Approval for Remedial Use Aquaworx7m Remediatoffm Alternative,Treatment System Page 7 of l l B. No System shall be used until an O&M agreement is submitted to the approving thority which: Provides for the contracting with the Company or its approved management company, trained by the Company as provided in Section VI (6), to operate the System consistent with the System's specifications and the operation and maintenance requirements specified by the designer and any specified by the Department; Contains procedures for notification to the Department and the local board of health within five days of a System failure or alarm event and for corrective measures to be taken immediately; c� Provides the name of an operator, which must be a Massachusetts certified operator if one is required by 257 CMR 2.00, that will operate and monitor the System. The operator_must inspect the System afleast every three months and anytime there is an alarm event. The System owner shall at all times have the System properly operated and maintained in accordance with this Approval, the designer's operation and maintenance requirements and the Company's approved operating procedures.Mhe.System_o_wner f-s all'notify Department and-the local approvingyauthority in writing within.seven t days of any cancellation;expirationor other change in_the.terms_an&6r c:onditio of �thelr O&M_agr,m CO Prior to transferring any or all interest in the property served by the System, or any portion of the property, including any possessory interest, the System owner shall provide written notice of all conditions contained in this Approval to the transferee(s). Any and all instruments of transfer and any leases or rental agreements shall include as an exhibit attached thereto and made a part thereof a copy of this Approval for the System. The_System owner shall send a copy of such written notification(s)wto the lop ai appr g authority_within_10 days_of such.notice beingygiv �The_S_ystem,owner-shall have-the=System_momtoedd quarterly for depth of ponding andr cpQgdived}oxygeafte O)`levels-int1i SAS--Should�the.System=exhibi -excessive? pon�ding levels after-three.:�months-of operation--(watersurfac"ewelevation-equal-to:or cgreaterrthan-the water surface-elevation--prior�to:installation--of_the-System);_ata, cminimum, the fo-1-lowing-parameters-shal-l-bermonitor-ed-pH BOD ;TSS de thof effluent-and DO in_the SAS-and-water use:MonitonngTshall--continue for at-least oriel year when at the writteri"request-oftbe-System owner-,rthe.Departmentmay_reduce t (moriito'ring.andareporting requirerrlerits If-after 120:days_operation,-the-System is rn (fai_lure,-the"".System_shall�be-removed-in-accordance-with.Section VI(7) By January 31St of each year for the prevlous,year;the-System owner-shall-submit t ;approving authority aall:data ccollected--in.accordance,withitem_6,:above,_and an-O&Mfi checklist-andTaTtechnoiogysheckl st-completed�by_the-System operatorTfoor each, inspection_performed dnring-th_erprevousNcalendar year.YA,copy ,of the=tec`hnology, cc-hecklistis-attachedto this.Approval Modified Approvallor Remedial Use " AquaworxTM RemediatorTM Alternativg Treatment System Page S of 11 8 (Prior-to the-issuance-of'a:Certificate-of-CompIiance for=theSystem;the-System owner shali�record--and/or r_egister_in_theLLappropnate--Registry o£Deedsyand/or--Lang► Registration Office,-allotice--disclosingthe—existence afithewalternative syste m-subject to=this_Approval-on-the property.,If_the property`subject=to_the Notice isuriregiste gland;_the_Notice-sliall.be.marginally-referenced,on.the owner''s deedTto_the propertyr GWltfiin.3:0 days,gf rec� ording-and/or=registering the Notice,_the System owner s_half i — mit-the-follow-i-ng-to--the-local approvi-ng-authority:(i)a c_ert fied;R_eg_stry copy the Notice bearing t_he book=and-page/instrument number and/or document-number;=and [(ii)if the property is unregistered�land;a Registry-copy of the owner's deed-to the property;bearngthe marginal reference. VI. Conditions Applicable to the Company I. The Company shall develop and submit to the Department within 60 days of the effective date of this Approval: minimum site evaluation criteria and installation requirements; an operating manual, including information on substances that should not be discharged to the System; a technology checklist; and a recommended schedule for maintenance and replacement of the plastic media essential to consistent successful performance of the installed Systems. The Company shall develop and submit to the Department within 60 days of the effective date of this Approval a standard protocol essential for consistent and accurate measurement of the performance of installed Systems, including procedures for sampling, collecting data and analysis of the System effluent and for evaluating effluent depth in the SAS. The sampling and analysis protocol shall be in accordance with the latest edition of Standard Methods for the Examination of Water and Wastewater. The Company shall make available, in print and electronic format, the referenced procedures and protocol above to owners, operators, designers and installers of the System. The Company shall submit to the Department within 60 days of the effective date of this Approval a complete manual on operation of the SAS monitoring unit and the procedures required to conduct monitoring of the System and any procedures that will be implemented should the monitoring System fail. 2. By January 3lst of each year, the Company shall submit a report to the Department, signed by a corporate officer, general partner or Company owner that contains information on the System, for the previous calendar year. The report shall include the following information: A. The total number of units of the System sold for use in Massachusetts during the previous year; the address of each installed System, the owner's name and address, the type of use (e.g. residential, commercial, institutional) and the design flow; B. Date when system was installed and started up; C. Tabulation of the sampling parameters and results with backup inspection and laboratory sheets; D. Statistical analysis of the sampling results including but not limited to average and mean values; status of the SAS including depth of effluent and change in depth over the operating year; Modified Approval'for Rem;dial Use v AquaworxTM RemediatorTM Alternative Treatment System Page 9 of 1 l E. Tabulation of systems that are in failure as described in 310 CMR 15.303 (1)(a)(1) or(2) due to excessive ponding of effluent in the SAS, reasons for non- compliance and any corrective action taken including but not limited to design, installation and/or operation or maintenance changes required to reach compliance; F. The inspection results recorded on a Department approved inspection form and a technology checklist. The forms must be completed by the System operator and submitted to the Department with the annual report. G. A general summary of the results for the year, any recommended changes to the design, installation and/or operation and maintenance procedures and a schedule for implementing those changes; and H. Warranty issues both resolved and unresolved or an explanation of any warranty claims that have been received and their resolution. thhe_-Sy mpany or_its designee-shall--re_v_iew-the--plans and-site-evaluation conducted-fora e System=prior to-the--saie-sale to--ens-ire-that the-proposed-instahat on of the -Sy_stem is at a-site-consi_stent-withithis Approval-and-thc�:System's:capabililies:They CompanyshallFcertif_y inzwnting thatAheTSystemTpi_anyandiexisting.s te-conditions fconfonwto--the:requirements:of this,Approval--and7any requirements-of t� he-Company, and-sh-allrsubm-it_a.copy of-that certifcationtto-the-local-approving_authority and;-t hey lSystem-owner,? iPrior�-to�the issuance o:f a C.ertificate�of-Gomplianceifor:the:S-ystem,-the--Company�shall� submit?to-the-local-approving-authontyand-theiSystem-owner a-signedicertifcation-that the--System-has-been-i-nstalled in--accordance-wi-th-the-C-ompany's—r-equir-ements;theme apt pr-oved%p,lan_and=this7Appr_oval:This:certification-in,no--way changes the--require m=ents of—ID--CMR_1?5.021-(3)� The�Company orzthe--Company-s=appr-oved-operation-and=maintenance:contractorishalb cmaintain-a--contract_with_the_-SystemTowne__�r that Provides for operating and maintaining the System with an operator that has been trained by the Company to operate the System consistent with the System's specifications and any additional operation and maintenance requirements specified by the designer or by the Department; Contains procedures for notification to the System owner, the Department and the local approving authority within five days of knowledge of a System failure and for corrective measures to be taken immediately; C Contains procedures for inspecting the plastic media bacterial source at each quarterly visit and if necessary replacing the media. At a minimum, the microbial inoculants shall be replaced annually; and LDI Contains a plan to determine if required after the first three months of operation why the effluent water surface elevations in the SAS are as high or higher then the water surface elevation when the System was installed. Modified Approval for Remedial Use f AquawomTm RemediatorTM Alternative Treatment System Page 1 g Oofll. - 6. The Company shall institute and maintain a program of operator training and continuing education, as approved by the Department. The Company shall maintain and annually update, and make the list of qualified operators available by February I"of each year. The company shall update the list of qualified operators and make the list known to users of the technology. TheiCompany=dial-l=provide-to-each-System--owner-a written-warrantyAransferable--toia new-owner that=incIud_es--the-fallowing? Refund of the cost of equipment and installation should the System continue in failure as described in 310 CMR 15.303(1)(a)(1) and (2) after 120 days of operation that is conducted in accordance with the Company's specifications and oversight; or Refund of the cost of equipment and installation should the System fail as described in 310 CMR 15.303(1)(a)(1) and (2) within two years of installation provided that the System owner has entered into and maintained an operation and maintenance contract with the Company and has operated the System in accordance with the Company's specifications. 8. The Company shall conduct a performance evaluation starting after the first 100 systems have been installed and operating for at least one year. A report shall be submitted to the Department no more than 180 days beyond the one year period evaluating whether at least 90 percent of the units installed for at least one year have demonstrated a reduction in depth and that the reduction in depth of the effluent elevation for the SAS systems has occurred within 120 days of start up or that ponding elevations in any new SAS systems are not excessive. Should the System not demonstrate the capability to reduce or eliminate ponding in 90 percent of the failed systems, the report shall detail the changes that must be made in site evaluation, design, installation and/or operation or maintenance to meet the goal and shall include a schedule containing a deadline for implementing those changes. No more than 100 systems shall be installed until the performance report has been completed and the results indicate that over 90 percent of the Systems are no longer in failure. The--Comp-any sshall_`i-nclude-copiesofthis7Approval--andstl e-procedures--and-,protocol deL scribed--m_S_ecfion VI(r)wit_h each-System that-is-sal . In any contract executed by the Company for distribution or re-sale of the System, the Company shall require the distributor or re-seller to provide each purchaser of the System with copies of this Approval and the procedures and protocol described in Section VI (1). 10. The Company shall notify the Director of the Wastewater Management Program at least 30 days in advance of the proposed transfer of ownership of the technology for which this Approval issued. Said notification shall include the name and address of the proposed new owner and a written agreement between the existing and proposed new owner containing a specific date for transfer of ownership, responsibility, coverage and liability between them. All provisions of this Approval applicable to the Company shall be applicable to successors and assigns of the Company, unless the Department determines otherwise. Modified Approval for Remedial Use , AquaworxTM RemediatorTM Alternative Treatment System Page 11 of 11 11. The Company shall furnish the Department any information that the Department requests regarding the System within 21 days of the receipt of that request. 12. If the Company wishes to continue this Approval after its expiration date, the Company shall apply for and obtain a renewal of this Approval. The Company shall submit a renewal application at least 180 days before the expiration date of this Approval, unless written permission for a later date has been granted in writing by the Department. This approval shall continue in force until the Department has acted on the renewal application. VII7--� Reporting �1 6M1--notices.and documents--required--to_b-ewsubniitted--to--the Departmentrby this:Approval, ,shall�be-submittod-to [Director , Wastdwater-NlanagementProgram Departmeritof-Environmental-P-otection Winter_Street:�--:5�thufloor Win,:Massachusetts,0-2-108� VIII. Rights of the Department 1. The Department may suspend, modify or revoke this Approval for cause, including, but not limited to, non-compliance with the terms of this Approval, inadequate system performance demonstrated by the annual report required in Section VI (2) or other relevant information, non-payment of the annual compliance assurance fee, for obtaining the Approval by misrepresentation or failure to disclose fully all relevant facts or any change in or discovery of conditions that would constitute grounds for discontinuance of the Approval, or as necessary for the protection of public health, safety, welfare or the environment, and as authorized by applicable law. The Department reserves its rights to take any enforcement action authorized by law with respect to this Approval and/or the System against the owner, or operator of the System and/or the Company. IX. Expiration Date 1. Notwithstanding the expiration date of this Approval, any System sold and installed prior to the expiration date of this Approval, and approved, installed and maintained in compliance with this Approval (as it may be modified) and 310 CMR 15.000, may remain in use unless the Department, the local approving authority, or a court requires the System to be modified or removed, or requires discharges to the System to cease. /r P�pFSHE rphy � •. Barnstable p� Town of Barnstable AO-Americaciry ISARNSA,5 , nA::S.. : Board of Health y m �p 1639. AIFo n�A�a' 200 Main Street, Hyannis MA 02601 Y 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi October 16, 2007 Mr. John L. Churchill, Jr., P.E. JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538 RE: 83 Lake Drive, Centerville, MA A= 230-084 Dear Mr. Churchill,_ You are granted multiple conditional variances on behalf of your clients, Francis and Janice Pattberg, to construct a replacement sewage disposal system at 83 Lake Drive, Centerville, Massachusetts. The variances granted are as follows: 310 CMR 1.5.211: The leaching facility will be located four (4) feet above the ground water table, in lieu of the minimum five (5) feet separation distance required. 310 CMR 15.221: To construct the soil absorption system two and one half (2.5) feet away from the side property line, in lieu of the minimum ten (10) feet separation distance required. 310 CMR 15.221: To construct the soil absorption system four (4) feet away from the foundation of the garage, in lieu of the minimum ten (10) feet separation distance required. 310 CMR 15.221: To construct the soil absorption system 3.6.feet away from the front property line, in lieu of the minimum ten (10) feet separation distance required. Q:\WPFILES\Churchill Pattberg2007.doc. Page.1 of 3 40 31!�„CMR,15.221: To construct the,septic tank 6.1 feet away from the foundation of the garage, in lieu of the minimum ten (10) feet separation distance required. 310 CMR 15.221: To construct the septic tank 7.4 feet away from the front property line, in lieu of the minimum ten (10) feet separation distance required. These variances are granted with the following conditions: (1) No more than two (2) bedrooms maximum are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type .rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to two (2) bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. (3) The designing engineer shall locate the neighbor's septic system components and ensure that the proposed septic system meets the minimum setback requirements contained in the State Environmental Code Title V. (4) The designing engineer shall revise the plan to show the location of the required monitoring device. (5) The designing engineer shall ensure that the system is designed in - accordance to the DEP design standards. (6) The wastewater effluent shall be tested quarterly for the first two years of operation for nitrates, TKN, pH, CBOD, TSS, TN, and alkalinity. (7) After the two year period of testing quarterly has ended, the applicant may request permission from the Board to request a reduction in testing frequency. (8) The applicant shall submit a copy of the signed two-year Operation and Maintenance Agreement (O&M) between the contractor and the homeowner to the Board of Health. The engineer or 0& M contractor shall conduct inspections to the /A system a minimum of twice yearly. QAWPFILES\Churchill Pattberg2007.doc Page 2 of 3 (S% The septic system shall be installed in substantial compliance with the ` - revised engineered plans. (10) The professional engineer shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the revised engineered plans. This permission is granted because the proposed plan appears to meet the maximum feasible compliance standards of the State Environmental Code, Title 5 and all of the Town of Barnstable Board of Health Regulations. Sin rely your ,, ayn Miller, M.D. Chairman QAWPFILES\Churchill Pattberg2007.doc Page 3'of 3 /(/5�01- N kit tHE DATE: �O 7 -•��� y FEE: BARNSfABLE, MASS. fp� n L 0 REC. BY Town of Barnstable SCHED. DATE: �0—I—O-.) Board of Health 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: ` Z LAKE -DWVE GI:Nte.Rwu-e Mq Assessor's Map and Parcel Number: MAP 710 - AV-CE1 $N Size of Lot:_0.1'e AcaEs t (oeR AmEs31i) Wetlands Within 300 Ft. Yes '� Business Name: N la No Subdivision Name: UXQ1J1%poEr F.sTAtEs APPLICANT'S NAME: Phone Did the owner of the property authorize you to represent him or her? Yes ✓ No PROPERTY OWNER'S NAME CONTACT PERSON 4&?rName: qw-%s ''i.. 4 JanncL L. Name: J.C. ' l at,�ro Address: o3 Ace 'D14v6, C.ENttttyu.LE M9 Address: 1hsa eaw8aow+r µ�v►awiyr E,wgabHgM Mq oz53b Phone: i r Phone:_�1�ia-o3� 5b 4K— 37_' VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space,ne,ded) C7 SEE APPENoctc "A" ge Aftrnotk "A" C( NATURE OF WORK: House Addition ❑❑❑❑❑❑ House Renovation ❑ T4ow�yr1a"�` ' Checklist (to be completed by office staff-person receiving variance request application) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form four(4)copies of engineered,plan submitted(e.g.septic system plans) — Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) — Signed letter stating that the property owner authorized you to represent him/her for this request Applicant understands that the abutters must be notified by certified mail at least ten days prior to riveting date at applicant's expense (forTitle V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/leasee only], outside dining variance renewals [same owner/leasee only],and variances to repair failed sewage disposal systems [only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Paul J.Canniff,D.M.D. REASON FOR DISAPPROVAL C:\Documents and Set tings\decol1ik\Local Settings\Temporary Internet Files\OLK1\VARIREQ.DOC q� V I SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. ignature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. Received by(Printed Name) C. Date D every ■ Attach this card to the back of the mailpiece, or on the front if space permits. . Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No SHUMAN,JON E&MELVIN R I THE 82AKE DR NOMINEE TRUST I 403B DED;HAM ST NEWTOI CENTER,MA 02159 3. Service Type I ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D: 4. Restricted Delivery?(Extra Fee) ❑Yes 2. F 7005 31,10 0002 8939723 -- - V A,R%A tjCrc PS Form 3811,February 2004 Domestic Return Receipt 1025957-M-15401 i UNITED STATES POSTAL SERVICEopp �` yy' CM g Permit S No.G-10 • Sender: Please print your name, address,and Zl1P r"11 s bo' X"4-' S JC Engineering, Inc. 2854 Cranberry Highway 'East Wareham, MA 02538-13. J SECTIONCOMPLETE THIS DELIVERY .■ Complete items 1,2,.and.3.Also complete A. ign ure item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address`on the,reverse ❑Addressee so that we,can return the card to you. B. Received y(Printed Name) C. D t of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? Ye 1. Article Addressed to: If YES,enter delivery address below: ❑No FREEMAN,PETER L TRS - � 1 { FREEMAN,DAVID TRUSTEE 125 PLEASANT ST APT 303 BROOKLINE,MA'02446 ! 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise --- - �� ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. (�� + 7005 i3lAt 0`0021`89i39 7281 1 Ps Form 3811,,February,2004 Domestic Return Receipt 102595-02-M-1540 l UNITED STATES POT :: ER 1 'd ;+ :a1 c? ':" s :first-Cla'3-u& Postage&.Fees Paid JL 7. • Sender: Please print your name, address,and ZIP+4 in this box • I I I JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538-1314 I I I_ r ffirrirrlrlririr,rfirirrirrld/ fir,rrll1Jrrlrlrfrrir rlrirrlf �•..Y rr COMPLETESENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your name and address on the reverse ❑Addressee so that.we can return the-card to you. g, geiv �d Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, ` or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No ' I FOWLER,GERALDINE 99 LAKE DR ,CENTRVILLE,MA 02632 3. Service Type ❑Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes i j7005litHii2 0002 38939} 7298 �Igtt�ANc� PS Form 381,1,February 2004 s s Domestic Return Receipt 102595-02-M-1540 UNITED STATES"`POSTAL�ERVI>✓Ea�st`�1a§s I hN,•M S r { y),Fn 3 v.rT' hL�fk„uu„r K�PeriE•t+.J�fu '"k0 rrrrrr, n • Sender: Please print your name, address, and ZIP+4 in this box • I I � JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA 02538-1314 j j. f F F i1�1riF 1e1F7i�ife�/-liff: Bllr:1/? 3illf rrjrl:/:.M1W. G I I SENDER: COMPLETE THIS SECTION COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature,,. item 4 if Restricted Delivery is desired. A nt ■ Print your name and address on the reverse X Addressee so that we can return the card to you. B. Received by(P Aed Name) C. Date of DejimM ■ Attach this card to the back of the mail piece, zoo or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No E � ARNFELD,LEO TR& ARNFELD,LORRAINE TR _ 1531 BEACON ST 3. service Type BROOKLINE,MA 02147 ❑Certified Mail ❑ Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. —` - 4. Restricted Delivery?(Extra Fee) ❑Yes 2' 7 G0 5 311,0 `0 0;O 2 j 8 9 3 9 ;7 2x6?, ; �' R i i `2�0- goii 1 PS Form 3811,February 2004 i Domestic Return Receipt i02595 o2-M-teao' I UNITED STATES POSTAL SERVICE $rlt es �'7e'E'Y d.y'b'.F^1 r•.'s �:�}ti, rt k' •4 .,... ,_, „iiHwi.. R`l"JrJ Permit No.G-10 • Sender: Please print your name, address,and 2IF+'4^ivrtrs'box • ''' I I � I l I JC Engineering, Inc. 2854 'Cranberry Highway East Wareham, MA 02538-1314 _,ice SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signat item 4 if Restricted Delivery is desired. X ElAgent 94.■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by(Printed Name)l Date of Delively ■ Attach this card to the back of the mailpiece, _Z O or on the front if space permits. D. Is delivery address different from item ? ❑ es 1. Article Addressed to: If YES,enter delivery address below: ❑No HORTON, SIDNEY K JR P 0 BOX 428 BRYANTVILLE,MA 02327-0428" 1 3. Service Type ❑Certified Mail ❑Express Mail I ❑Registered U Return Receipt for Merchandise --- _ J ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes l� 17`0G51 3110 10002''8939 7274 ' PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 q T f.1C L, ,.ymWrw"' tomb Yam' UNITED STATES IFOSTAL SERVICE ww °"e ""`" �r►>�7:of ai ee' aid . �_.. "�. • Sender: Please print your name, address, and ZIP+4 in this box • I JC Engineering, Inc. 2854 Cranberry Highway East Wareham MA - 02538 1314 r BOH ABUTTERS LIST 83 LAKE DRIVE, CENTERVILLE, MA 02632 MAP PARCEL (S) OWNER'S NAME & MAILING ADDRESS Jon E. &Melvin R. Shuman 230 81 The 82 Lake Drive Nominee Trust 403B Dedham Street Newton Center, MA 02159 David L. Freeman, Trustee of 230 82 Peter L. Freeman Trust 125 Pleasant Street, Apt. 303 Brookline, MA 02446 Geraldine Fowler 230 83 99 Lake Drive Centerville, MA 02632 Leo & Lorraine Arnfield, Trs 230 80 1531 Beacon Street Brookline, MA 02147 Sydney K. Horton, Jr. 230 85 P.O. Box 42 Bryantville, MA 02327 I LETTER OF TRANSMITTAL JC Engineering Inc. Civil&Environmental Services 2854 Cranberry Highway Telephone: 508-273-0377 E.Wareham,MA 02538 Facsimile: 508-273-0367 TO: jown of Barnstable DATE: 10/31/07 JOB NO. 1260 `Board ofH Ea-lth RE: Revised Septic Plan 200 Main Street 83 Lake Drive Hyannis,MA 02601 Centerville,MA WE ARE SENDING YOU: X Enclosed _ Under separate cover via X the following: Report _Prints _Brochures Shop Drawings Specifications —Copy of Letter —Change Order Forms Please find enclosed four(4)REVISED septic plans per Board of Health comments for your review and approval. _— THESE ARE TRANSMITTED as checked below: X For Approval _Resubmit Copies for Approval For Your Use _Approved as Noted Copies for Distribution As Requested Returned q _ Approved as Submitted Returned _For Review and Comment For Your Information 4 REMARKS Should you have any questions,please feel free to contact our office. r rn ZZ COPY TO: File(1),Capewide(2) SIGNED: /f. WcKdel Pime tel, E.I.T. Health Master Detail Page 1 of 1 1 }� Hlth Master Logged In As: TOWN\health Health Master Detail Tuesday, J( Application Center Parcel Lookup Parcel Septic Perc Well Fuel Tank Parcel: 230-084 Location: 83 LAKE DRIVE, CENTERVILLE Owner: PATTBERG, FRANCIS R &JANICE L Septic 1, 12/19/2007 New Septic... Permit number: 2007577_� Permit type: I Select type = Comple- Issue date : 12/19/2007 Complete date p __— _ Type/Size 3-500 gal leach chambers w/4' stone Septic tank size: .'1500/5 T /Size of SAS: . � i ._-- - ------ -- —— _ ._.._---------- Installer: 'Capen, Richard M. , Capewide Enterprises, LLC I C< I/A service type: Select service J-' Innovative/Alternative Technology type: Select IA type Variance date : Abandon complete date : ' Abandon perm Repair deadline date : Repair notification date Comments: 2 BR& DEED RESTRICTION. Capewide. I/A=Aquaworx Remedlator.NEE[G(�O Del( New Inspection... Number Date Inspector 0 fflSelect Inspector Comments: i vl - - — -- - - - -- i i Save Septic Changes ' Return to Lookup http://issgl2/intranet/healthMaster/HealthMasterDetail.aspx?ID=230084 6/2/2009 JC ENGINEERING, Inc. Civil'& Environmental Engineering 2854 Cranberry Highway East Wareham, Massachusetts 02538 Ph. 508-273-0377—Fax 508-273-0367 APPENDIX "A" In accordance with 310 CMR 15.401-15.405, we are requesting the following local upgrade approvals from 310 CMR 15.211 and 310 CMR 15.212: (1) A 1.0' variance (5.0'—4.0') for minimum separation from groundwater to the proposed leaching facility. (2) A 7.5' variance (10.0' —2.5') from the proposed SAS to the side property line. (3) A 6.0' variance (10.0' —4.0') from the proposed SAS to the existing garage. (4) A 6.4' variance(10.0' —3.6') from the proposed SAS to the front property line. (5) A 3.9' variance(10.0' —6.1') from the proposed septic tank to the existing garage (6) A 2.6' variance (10.0' —7.4') from the proposed septic tank to the front property line. ENCLOSED DINING PORCH ROOM KITCHEN BED ROOM BATH 1 LIVING ROOM BED ROOM GARAGE FIRST FLOOR Floor Plan of 83 Lake Drive, Centerville, MA JC Engineering, Inc. 2854 Cranberry Highway September 26, 2007 E.Wareham, MA 02538 Prepared for Capewide Enterprises (508)273-0377 Town of Barnstable P# V �• VJ Department of Regulatory Services BABNSTABLK i Public Health Division Date MA68. w v� ib39• `pro 200 Main Street,Hyannis MA 02601 plFn MA't� Date Scheduled jor Time Fee Pd. v� Soil Suitability Assessment for Sewage Disposal 1C41c1Q 'CidN2(llQ,\ Witnessed By: 170�d1A 1 10(Q,nC�t Performed By: • LOCATION & GENERAL INFORMATION Location Address Owner's Name 83 (eAKe1�v�,Ce �+c�vt`ti� 4:moc;3 Address-63 U LL �O 6\1-p— Assessor's Map/Parcel: s3o�t3�y Engineer's Name eej� �13 NEW CONSTRUCTION REPAIR Telephone# ' al Land Use WKI A aloop, �Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet Area tt Drinking Water Well ft Drainage Way ft Property Line ft Other tI SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to.holes) SIR pla-(A Uj 610 _ C) f u '7 110 b5s Parent material(geologic) Depth to Bedrock I Depth to,Groundwatcr. Standing Water in Hole: Q D l0.95 Weeping from Pit Face ba--- Estimated Seasonal High Groundwater 7 V b�3 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Dvec� 005QrJc,{'20 i Depth Observed standing in obs.hole: \ in. Depth to soil mottles: ln• Depth to weeping front'side of obs.hole_T in. Groundwater Adjusirneni Index Well# Reading Date: — Index Well level — Adj.factor Adj.Groundwater Level= Y.------ _ . PERCOLATION TEST Date ' —aTime , C=, Observation 9 r Hole# ` Time at 9" Depth of Perc G '- Time at 6" 0 �_ Start Pre-soak Time a Time(9"-6") A, i End Pre-soak + Rate Min./Inch Gam-` Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) N � \ Original: Public Health Division Observation Hole Data To Be Completed on Back----------- fi ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)weelc prior to beginning. Q HEAUTH/WP/PERCFORM DEEP OBSERVATION HOLE LOG Hole # Depth.from Soil 1-lorizon Soil Texture Soil Color Soil Other Surface(In.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C.hLOO yl� DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) 0'10 " ir L L �� — LSp+ cn� l �'�r iZ 0 <r04M fir' 3Z n c�yl �� 1 y `(� Jr/�9 DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%-Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No— Yes Within 100 year flood boundary No -� Yes ^ Lepth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? &S If not,what is the depth of naturally occurring pervious material? �p . l .Certification I 0 2 �V(date)I have passed the soil evaluator examination approved by the T certify that on Department of Envirorunental Protection and that the above analysis was performed by me consistent with the required training,expe ise a e perience described in 310 CMR.1.5.101177; . Signature Date, Q:l-1 CALTH/W P/PERCFORM �o i`-f. °q 67 . -- JL_ - 1 �-T— -r p �E 1�,A L - - - _ c � a�IFTl .. ..... .--.... ..... .. .. .. ... _ _ - .. -.... .- L . -_. .- .- -R 1 t P .Li - ....... _.. -. . TE LL, , FOR cl.l Ater= aA ,p ATL � 4. - Avo PJAST6 � SUITE to OR, CL04)? 1 b . PLASH C A comma E 17AI46A %I fo SP SA&b Cry �I/ - T.O.F. = 40.2'± AIR PUMP IN F.G. OVER TANK EL. = PROVIDE PRECAST CONCR. FINISH GRADE OVER D-BOX = 40.4'± WATERTIGHT BASIN , EXTENSION RISER TO WITHIN FINISH GRADE OVER CHAMBERS = 40.38' - 40.68' 3/4"TO 1-1/2" DOUBLE WASHED FINISHED GRADE 20"MIN.ACCESS 39'4 ±. 6" OF F.G. OVER ALL COVERS DISTRIBUTION BOX RISER AND REMOVABLE SLOPE @ 2% MIN. OVER SYSTEM STONE TO CROWN OF PIPE @ FOUNDATION = VARIES 1.COVER(TYP FOR 3) COVER TO WITHIN 6"OF GRADE GENERAL NOTES 5" DIA. OUTLET(S) 4" SCHEDULE 40 PVC MIN SLOPE 1% ACCESS BOX WITH COVER TO GRADE 2" OF 1/8"TO 1/2' DOUBLE 6 MlN. SEE NOTE#21 WASHED STONE 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND _.._ 36"MAX. F 4" PVC OUT CONSTRUCTION METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE 2" PVC TEE TO LEACHING TOP OF SAS - 39.63' PLACE RISERS ON STATE ENVIRONMENTAL CODE AND ANY APPLICABLE LOCAL RULES. FACILITY , 9" MIN. ALL CHAMBERS I. 2" DROP MIN. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF 38.80 36" MAX. 39.MO' HEALTH AND THE DESIGN ENGINEER. � MIN.SLOPE@1% 6" 3" 3" DROP M 3" 9" WITH INLETS TO 6" ---------- - BREAKOUT EL = PROPOSED 4" _-_ - OF FINISHED GRADE 3. 4" SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED SCHEDULE 40 PVC � �� 14" 37.18' IN DISPOSAL SYSTEM UNLESS OTHERWISE NOTED. EXISTING 4 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN C.I. DRAIN ' AIR PUMP 0 0 0 0 0 0 op ELEVATION = 39.30' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS LINE 0 1, pp pp ppp A 40 MIL GEOMEMBRANE LINER IS PLACED AT LEAST FIVE FEET FROM S.A.S. AND THE TOP AQUAWORX 48„ 1� pp 0 0 0 0 0 0 0 = OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. REMEDIATOR + CD pp pp 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 37.43' 39.12' 38.95' 2.0' 2 0 4.0' 4.0' 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 6.1' I 3.00' 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO �6„ CRUSHED STONE (TYP.) BACK FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR 23.7 1500 GAL. OVER MECHANICALLY 22.3' COMPACTED BASE 11.0' INSPECTION. SYSTEM IS NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH AND DESIGN ENGINEER. 6" CRUSHED STONE 5 OUTLET DISTRIBUTION BOX 37.80' GROUND WATER ELEV= *34.80' 8. ELEVATIONS BASED ON N.G.V.D. DATUM OF 39.43' ESTABLISHED ON A 22"ZABEL FILTER COMPACTED BASE EL.OVER MECHANICALLY TO BE INSTALLED ON A LEVEL STABLE 5' MIN. * OF WEQUAQUET LAKE PER BOH NAIL SET IN PAVEMENT AS SHOWN ON PLAN. O MODEL#A1801-4x22 GAS BAFFLE BASE. FIRST TWO FEET OF OUTLET (3' min. w/variance) 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION NOTE: PROPOSED 1500/500 GALLON TWO COMPARTMENT H-20 SEPTIC: TANK PIPES TO BE LAID LEVEL. 3 - LC-6 CHAMBERS (2' reduction allowed per DEP THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE SEPTIC TANK SHALL BE LENGTH 12'-2" WIDTH 6'-8" DEPTH 6'-2" DIMENSION AS PER TYPICAL CHAMBER PROFILE approval letter last modified 8-21-07) CHAMBER END VIEW AT 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY bVIGGIN PRECAST CORP. CROSS SECTION VIEW DISCREPANCIES TO THE DESIGN ENGINEER. WATERPROOF AND WATERTIGHT.NCO AG ELEVATION PRIOR b E H I I G 1 AIN K P RO F I LF POCASSET, MA H-20 DI STRI BU , ..ION BOX DETAIL CHAMBER DETAILS REMOVE & REPLACE NOT NEEDED BASED ON ASSUMED 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE TO ANY WORK & NO FIFY ENGINEER IF DIFFERENT. NOT TO SCALE (300)564-6774 NOT TO SCALE NOT TO SCALE PERC RATE OF LESS THAN 5 MPI FOR B-SOIL. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR SWING TIES TEST PIT DATA TEST PIT DATA ZONING REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH . ' on DETERMINATION FROM APPROPRIATE AUTHORITY. 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS DESCRIPTION GC 1 GC 2 *�7 Pt INSPECTOR: Donna Miorandi INSPECTOR: Donna Miorandi a LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE E e$ SOIL EVALUATOR: Michael Pimentel, E.I.T. SOIL EVALUATOR: Michael Pimentel, E.I.T. Benchmark LAKE pRw - / SEPTIC COVER IN (1) 22.8' 10.3 � - � L C U S - THEY SHALL WITHSTAND H-20. LOADING. Nail in Pavement P xE) % Pt CIF 'j' DATE: August 8, 2007 DATE: August 8, 2007 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND Elev. = 39.43' WIDE P SEPTIC COVER OUT (2) 22.0' 15.2' lttie i FINES. (40' { \ J , TEST PIT#: 2 TEST PIT#-. 1 N.G.V.D. 1 / a LEACHING CORNER 3 4-8 14.3' Pt t" 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE O r� reat ~- _ ELEV TOP= 39.70' ELEV TOP = 39.80' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. EXISTING CESSPOOL TO BE , r3 PUMPED AND FILLED WITH LEACHING CORNER(4) 11.1 25.3' Pt .., ELEV WATER- 34.1' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, FINES PROPOSED 1500/500 GALLON TWO . .?r• - ELEV WATER= 34.2' CLEAN, COARSE SAND 3\ •a/V'" - OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15255(3). COMPARTMENT H-20 SEPTIC TANK �� o LEACHING CORNER(5) 28.8 32.8' ' . ": PERC RATE - < 2 MIN/IN , . t J - PERC RATE _ < 2 MIN/IN 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN rn APPROXIMATE LOCATION OF CURB STOP % j� S�No�6�Z ' LEACHING CORNER(6) 27.0' 25.4' •` * • ' . �< SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. � - / _/� 3 \39� 3 \ •' { ♦ DEPTH OF PERC = DEPTH OF PERC = 32'-50' 16. PROPOSED PROJECT IS LOCATED WITHIN: \ �'* r 44 PROPOSED H 20 i • ' `+t r , + • 4 TEXTURAL CLASS: 1 TEXTURAL CLASS: 1 ASSESSORS MAP 230 PARCEL 84 � DISTRIBUTION BOX �.............. � ' �� � ` • � r /f ym` '+ •{°, • l OWNER OF RECORD: FRANCIS R. &JANICE L. PATTBERG C12 _� CB •�,* ; • 11' + 0" 39.70' 0" 39.80' WV X \ MAP 230 . • ,� ADDRESS: 83 LAKE DRIVE L DST. • • Fill � ��X /i, •, � • , • Fill o E 25-00' O M --a CB/DIST. R SEA- �'st6," PARCEL 83 � ' + + • ., CENTERVILLE, MA 02632 �, , + *� i ' � 6" 39.20' 6" 39.50' AGE F / (6) X L=26 � LANDSCAPED \ \ �6, N/F FOWLER ; + • r' k, Loam Sand FEMA FLOOD ZONE B + C SHELL ' \ AREA 10Yr3/2 A AS SHOWN ON COMMUNITY PANEL# • . , E' q Y Loamy Sand 250001 0005 C 0 3 , O� tow• • • ''" s 10Yr3/2 17 R=25. a � ���•'?� ,�p`� c,, � TP 1� .` DRIVE X � i 39.8 ^ a ' 11" 38.88' PLAN REFERENCE: ` ill, 38.78' 1. PLAN BOOK 122, PAGE 89 UP 498/2 '��' / '�' +` I,f _ • , Loamy Sand Loamy Sand 18. DEED REFERENCE: (5) O TP 2 X / �� ' 26 1f]o'a d B 10Yr5/6 B 10Yr5/6 > - I. 1. BOOK 961, PAGE 487. l - 9.7' (2) � i ,, 32" 37.03' 32" �: 37.13' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. • . f Perc = = 20. PROPERTY LINE INFORMATION IS APPROXIMATE, ONLY. FHIS PLAN IS TO BE USED ONLY GUY N - _- � 50" "r 35.63' � FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY ` ` .- / Mottling @ 74' Mottl ng @ 74' FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 74 Medium Sand = 33.53 74 = 33.63 C 2.5Y6/6 Med am Sand 21. A 4" PERFORATED SCH. 40, PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION, TO A O _= :y 3 O G� y/ / /� LOCUS PLAN C 2.5Y6/6 DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A PROPOSED 3 LC-6 _ _-- ) Weeping 100" REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. QP GL G 100" p g @ - 31.37' 1001, Weeping @ 100' - 31.47'LEACHING CHAMBERS G GC-2 �? - 22. IN ACCORDANCE WITH 310 CMR 15.401-15.405, THE FOLLOWING LOCAL UPGRADE 9 Standing @ 108" Standing @ 108" O - SCALE: 1" = 1000' 108" - 30.70' 108" 30.80' BH _ �. - = APPROVALS APE REQUESTED FROM 310 CMR 15.211 & 15.212: PROPOSED INSPECTION PORT w/ 11 39 O C- \ / / 120" 29.70' MONITORING DEVICE (SEE NOTE 2 TO_" " (4) #$3 `� / / 120" 29.80' 1. A 2.0'VARIA�fCE (5.0'- 3.0') FOR MINIMUM SEPARATION FROM GROUNDWATER TO THE PROPOSED LEACHING FACILITY. CONTRACTOR BELOW) EXISTING 2. A 7.5'VARIANCE (10.0'-2.5') FROM THE PROPOSED SAS TO THE SIDE PROPERTY LINE. +1 n F S I r N nATA 3. A 6.0'VARIANCE (10.0' -4.0') FROM THE PROPOSED SAS TO THE EXISTING GARAGE. GARAGE 2-BEDROOM DWELLING 4. A 6.4'VARIANCE (10.0' - 3.6') FROM THE PROPOSED SAS TO THE FRONT PROPERTY LINE. NUMBER OF BEDROOMS 2 DEED RESTRICTION TO BE FILED DOSING & STORAGE REQUIREMENTS 5. A 3.9'VARIANCE (10.0' -6.1') FROM THE PROPOSED SEPTIC TANK TO THE EXISTING GARAGE. AIR PUMP, LOCATION TO BE --39- TOF =40.2'± j DESIGN FLOW 110 GAL/DAY/BEDROOM 6. A 2.6'VARIANCE (10.0'- 7.4') FROM THE PROP. SEPTIC TANK TO THE FRONT PROPERTY LINE. DOSING REQUIRED: DETERMINED BY OWNER i. / / TOTAL DESIGN FLOW 220 GAL/DAY DESIGN FLOW: 4 CYCLE GPD l CID O��c / / DESIGN FLOW X 200 % = 440 GAL/DAY 220 GPDA=5 GAUCYCLE LEGEND APPROXIMATE LOCATIONOHO _ '38- / / USE PROPOSED 1,500/500-GALLON TWO COMPARTMENT SEPTIC TANK DISTANCE REQUIRED BETWEEN PUMP X100.00 EXISTING SPOT GRADES OF EXISTING CESSPOOL o INSTALL 3 - LC-6 CHAMBERS ON AND PUMP OFF FLOATS: EXISTING CONTOURS 55 GAL/CYCLE 125 GAL/FT = .44 FT/CYCLE SIDEWALL CAPACITY (USE 0.5'TO PROVIDE FOR BACKFLOW) PROPOSED CONTOURS 102 o (LENGTH +WIDTH)(2) (1' HIGH) (0.74 GPD/S.F.) = GAUDAY STORAGE REQUIRED ABOVE WORKING LEVEL: 220 GAL. -X-X-X-X-X X-X-X- EXISTING FENCE LINE --37� i STORAGE PROVIDED ABOVE WORKING LEVEL:250 GAL. (22.3'+ 11.0') (2)(1') (0.74 GPD/S.F.) = 49.3 GAL/DAY ❑/H/W EXISTING OVERHEAD WIRE BOTTOM CAPACITY / MAP 230 / / / (LENGTH x WIDTH) (.74 GPD/S.F.) = GAUDAY - W W EXISTING WATERLINE PARCEL 84 �3 / / (22.3'x 11.0') (.74 GPD/S.F.) = 181.5 GAL/DAY TEST PIT LOCATION 0.18 ACRES± / � � / TOTALS: O O O PROPOSED 1,500/500 GALLON / flr�:v:ket The Aquaworx Rernediatar �h/ / / / TOTAL NUMBER OF CHAMBERS: 3 TWO COMPARTMENT H-20 SEPTIC TANK Components MAP 230 TOTAL LEACHING AREA: 311.9 SQ.FT. PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE TOTAL LEACHING CAPACITY: 230.8 GAL./DAY ' N/F HORTON ❑ PROPOSED H-20 DISTRIBUTION BOX INSTALL 1-1/4" PVC TO HOUSE. JOINTS TO BE MADE MELODY POND- WATERTIGHT. WIRE PUMP AND FLOATS TO SIMPLEX PROPOSED 1/2" SCH. 40 PVC AIR LINE I ri:= / (NGVD EL. = 32.7'± BASED ON CONTROL PANEL No. 1-CC2 NEMA-1 MFG. HOOVER r v PROPOSED LC-6 LEACHING CHAMBER / INSTRUMENTS. � rb FIELD SURVEY ON 10-18-07) 2 11-13-07 MCP JLC ADDED MONITORING DEVICE & EXIST. CP i / NEMA 4 JUNCTION BOX CORROSION RESISTANT HOISTING CABLE 7 x 19 STAINLESS STEEL Finc,iri.70 c:.rig'..t i .'.�,ie,� / / / / & LIQUID-TIGHT CABLE CONNECTORS 1/8" DIA. / 1,760 LB. STRENGTH 1 10-30-07 MCP JLC CONVERT ELEVS. TO NGVD, ADDED AQUAWORX / SUPPORTED CONNECTORS SUPPORTED BY 1-1/4" REV. DATE BY APP'D. DESCRIPTION PVC CONDUIT, JOINTS TO BE MADE WATERTIGHT 2" BALL VALVE w/ UNONS GEORGE FISHER CO!MOD�L NO. 60CH. 80 C PROPOSED SEPTIC SYSTEM UPGRADE NOTE TO OWNER: - OF MA PREPARED FOR: -•�r�:t�<n,�l �:v�t�:+4,t ;tirmt-t:� 1.) COVERS MUST BE BROUGHT TO GRADE � M 3" t 2" SCH. 40 TO D-BOX sr yV`=y� . IF DRIVEWAY IS PAVED IN FUTURE. f o i �� -1 3JOHN CAPEWIDE ENTERPRISES - / T CONDITIONS I � -�1 MOLD PRECAST TANK KITH RUBBER � R. N 2.) OWNER SHALL ADHERE O CO O S ALARM ON GASKET FOR INLET AND OUTLET FARRE \ / `9 LIQUID PUMP oN - KNOCKOUTS. INSTALLER TO ALSO USE No. 33590 o LOCATED AT OF DEP APPROVAL FOR THE AQUAWORX LEVEL ; O For a Aquaworx representative, call SYSTEM DATED MAY 26, 2004 (LAST o HYDRAULIC CEMENT AT ALL PIPE t,, 83 LAKE DRIVE / MODIFIED AUGUST 21, 2007). PUMP N CONNECTIONS TO ENSURE WATER -'�° �✓ Alan Barboro w/ Infiltrator Systems, OFF TIGHTNESS. CENTERVILLE, MA 02632 , n rtrl��•rf Inc. at 1-877-278-2979 - Pkc (2)WIDE ANGLE CONTROL FLOATS " SCH. 40 TEE w/CLEAN-OUT CAP - .k niet Hs o o SCALE: 1 INCH = 10 FT. DATE: SEPTEMBER 24, 2007 Aquaworx Remedlator specifications: (BARNES 073618) o 2" BALL CHECK VALVE SCH. 80 PVC 100 _ Fane Bubble 1: PUMP ON/OFF 120 ACTIVATION P.S.I. FLOWMATIC MODEL No. 208S o s 10 20 ao FEET Air Diffuser NOTE TO CONTRACTOR: 2: ALARM ACTIVATION jN I Column diameter at top 12 1.) MAGNETIC MARKING TAPE SHALL BE 1/4"WEEP HOLE IN DISCHARGE PIPE �j PREPARED BY: 2"SCH. 40 PVC DISCHARGE PIPE Y° JOHN L. ; Column diameter at base 15" PLACED ALONG THE TOP EDGE OF EACH NOTES: Mjkk'Ffl'Ll JC ENGINEERING, INC. SEPTIC SYSTEM COMPONENT. 1.) TANK TO BE WATERTIGHT CERTIFIED BY MANUFACTURER. BARNES SE411 PUMP, 0.4 H.P., 115 V, 1750 CIVIL 2854 CRANBERRY HIGHWAY Total height 36" No A,sc7 ' g 2.) REFER TO SECTION II-5 OF DEP 2.) ALL ELECTRICAL CONNECTIONS ARE TO BE MADE OUTSIDE THE TANK. RPM, 2 DISCHARGE PASSING 1-1/2 SOLIDS EAST WAREHAM MA 02538 Weight 38 lbs APPROVAL LETTER (TRANSMITTAL (IMP. DIA. 4.25")OR EQUAL 8�11r] Bono M SITE PLAN , Flow Rate 600 GPD / 4 bedroom house NUMBER W031991) FOR DETAILS. PUMP CHAMBER DE T / lL. �^- 508.273.0377 SCALE: 1" = 10' Drawn By: BSM Designed By:MCP Checked By: JLC JOB No. 1260