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HomeMy WebLinkAbout0025 LAUREL ROAD - Health 25 Laurel Road Centerville A= 230 — 035 6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is Centerville MA 02632 04/22/10 required for 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. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: Vl key to move your cursor-do not Mike Hudson use the return Name of Inspector key. � Septic-wiz Environmental Services t�l Company Name 31 Midway Dr Company Address Centerville MA 02632 ary/town State Zip Code 508-367-5669 DEP SI#4254 Telephone Number License Number B. Certification - C I certify that I have personally inspected the sewage disposal system at this address and thifthe information reported below is true, accurate and complete as of the time of the inspection. Thhe insction was performed based on my training and experience in the proper function and° naintenance of orite sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340-7, Title 5(310 CMR 15.000).The system: Z Passes ❑ Conditionally Passes ❑ Fails k-n ❑ Needs Further Evaluation by the Local Approving Authority '11r, 41L— 04/23/10 Insp or's Sign ure 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. 25 Laurel Rd-T5 Inspec(10)•08l06 Title 5 Official Inspecction Fonn:Subsurface Sewage Disposal yslem Pegof 15,b Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 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: ® 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: System installed April 2008 and has not been used. System is for a 3 bedroom design (330 GPD)and consists of a 1500 gallon septic tank, D-box and (1) 4'Wx2'Hx70'L leaching trench.All system components are in excellent condition and working properly. ,, - 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. Answer yes, no or not determined (Y, N, ND) in the ❑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. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed 25 Laurel Rd-T5 Inspec(10)-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Q I A B) System Conditionally Passes(cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: 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 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. 25 Laurel Rd-T5 Inspec(10)-08/06 Tide 5 official Insp ection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Laurel Rd Property Address Dennis Aceto Owner Owners Name information is required for every Centerville MA 02632 04/22/10 page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): 1 ❑ 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 %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. 25 Laurel Rd-T5 Inspec(10)-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Laurel Rd Property Address Dennis Aceto Owner Owners Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems(cont.): Yes No ❑ ® 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. I A, _ 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. 25 Laurel Rd-T5 Inspec(10)•08/06 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown 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)] 25 Laurel Rd-T5 Inspec(10)•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 is Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '<0 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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 years usage(gpd)): 2008- 13 GPD 2009-0 GPD Sump pump? ❑ Yes ® No Last date of occupancy: 2007 Date lAr - CommerciaUlndustrial 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: Last date of occupancy/use: Date Other(describe): 25 Laurel Rd-T5 Inspec(10)•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 't 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: System has not required pumping Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: N/A gallons How was quantity N/A q y pumped determined? Reason for pumping: N/A 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 2 years. Installed April 2008 via as-built card on file at Barnstable BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 25 Laurel Rd-T5 Inspec(10)•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M yv y 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): " Depth below grade: 21feet 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.): Septic Tank(locate on site plan): Depth below grade: 5"feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: N/A years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ® No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 5'8"WX10'6"Lx5'8"H - 1500 gallon Sludge depth: No sludge at time of inspection Distance from top of sludge to bottom of outlet tee or baffle N/A Scum thickness No scum a time of inspection Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A How were dimensions determined? visual, sludge judge, measured probe, floodlight, mirror 25 Laurel Rd-T5 Inspec(10)-08/06 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's(dame information is required for every Centerville MA 02632 04/22/10 page. Cityrrown 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.): Once system is used regularly recommend pumping 1x every 36 months. 1500 Tank has 2 sched 40 pvc inlet tees and 1 pvc outlet tee to d-box, tank is new and structurally sound, liquid level normal, tank appears level w/no signs of leaks iJ)Ar - Grease Trap(locate on site Ian : P ) Depth below grade: t feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): 25 Laurel Rd-T5 Inspec(10)•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 1" below 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.): D-box is level and working propery. Top of d-box V below grade. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 25 Laurel Rd-T5 Inspec(10)•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: (1) 70' long ❑ 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.): Loamy sand to med sand soils, no signs of hydraulic failure, ponding, damp soil or abnormally lush vegetation. Bottom of SAS 5.8' below grade. 25 Laurel Rd-T5 Inspec(10)•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection. Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is required for every Centerville MA 02632 04/22/10 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) rJl Af— Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 014 Privy(locate on site plan): I Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 25 Laurel Rd-T5 Inspec(10)-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 4 M 25 Laurel Rd Property Address Dennis Aceto Owner Owner's Name information is Centerville MA 02632 04/22/10 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 25 Laurel Rd-T5 Inspec(10)•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M , 25 Laurel Rd Property Address Dennis Aceto Owner Owners Name information is required for every Centerville MA 02632 04/22/10 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope 4 3=1 ® Surface water tJ ® Check cellar tJ�N ® Shallow wells t-/11k- Estimated depth to ground water: 132" 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: 04/23/10Date ❑ 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: Reviewed USGS water resource and topgraphic maps You must describe how you established the high ground water elevation: Reviewed USGS water resource, soils and topographic maps. Reviewed 2 Test Hole Logs by SE Dave Mason performed 02/08/08 indicating medium sandy soils and no groundwater encountered at a depth of 132" below grade. Bottom of SAS trench is 5.8'below grade elevation of 41.2' 25 laurel Rd-T5 Inspec(10)•08106 Title 5 Official Inspection Form:Subsurface Sew age wage Disposal System•Page 15 of 15 Laurel RD d 3 N W L Q 25 Laurel Rd Centerville, MA 02632 3 Bedroom House A 1-18,6' B 1-34,7' A B 2-27,2' 2-48' 1500 Gallon O O Septic Tank 1 D-box Vent 2 4'Wx2'Hx70'L Leaching Trench - 7f o .--- % "1 �--- rn t 2D 3 - �Y 1 l o Yk tY 7Z Ll -*I,- it 4� � o -� xis� � see n Ca /t� � f►/ -7 ' y 1 � J r �-- yo' S" -�--� r THE COMMONWEALTH OF MASSAC14USETTS ——————— ——— BARNSTABLE, MASSACHUSETTS Certificate of. Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded ( ) Abandoned �TFi has bpen con�lpcted.in_�cEordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ' dated Installer - -- ��r Designer. f { Ge __cry-- :: bedrooms— , Approved design flow PP g .— -- and The issuance of this Permit shUotbe cer� rued as a guarantee that the system wi41 T,�jndp�gngd Date ---- —� rC..;- Inspector naiii�tavic r►a�c��iiig acaiVii i�wuiw 1 use • "` I 2008 Property Assessment Lookup H;rrie.Gel artn nts s=.e<.<or:.i:.ivislcn Property.assessment Search ReSUItS New Search, - _New Interactive Maps Owner: 2008 Assessed Values: EAGAN,MARY CATHERINE 25 LAUREL ROAD Appraised Value Assessed Value MaplParcel/Parcel Extension Building Value: $193.100 $193,100 230 /035/ Extra Features: $2,600 $2,600 Outbuildings: $400 $400 Mailing Address Land Value: $161,800 $161,800 EAGAN,MARY CATHERINE %CAMBRIDGE CAPE COD REALTY ASSOC, Totals $357,900 $357,900 LLC 11 MARKET STREET Residential Exemption Received=$105,082 CAMBRIDGE,MA.02139 2008 REAL ESTATE Tax Information: Tax Rates:(per$1,000 of valuation) Community Preservation Act Tax $49.91 Fire District Rates Town Barnstable FD-All Classes $2.04 $6.58 C.O.M.M.-All Classes $1.03 Commercial C.O.M.M.FD Tax(Residential) $368.64 Cotuit FD-All Classes $1.33 $5.80 Hyannis-Residential $1.53 Personal Property Town Tax(Residential) $1,663.54 Hyannis,-Commercial $2.35 $5.80 Hyannis-Personal $2.35 Other Rates W Barnstable-Residential $1.86 Community Preservation Act 3%of Town Tax W Barnstable-Commercial $1.86 W Barnstable-Personal $1.86 Total: $2,082.09 Construction Details Building Property Sketch & ASBUILT Cards Property Sketch Legend Building value $193,100 Interior Floors Hardwood Style Ranch Interior Walls Drywall Model Residential Heat Fuel Oil Grade Average Plus Heat Type Hot WaterII Stories 1 Story AC Type None Exterior Walls Wood Shingle Bedrooms 3 Bedrooms Roof Structure Gable/Hip Bathrooms 2 Full Roof Cover Asph/F GIs/Cmp living area 1698 Replacement Cost $221986 Year Built 1976 Depreciation 13 Total Rooms 7 Rooms Land CODE 1010 ASBuilt Card N/A Lot Size(Acres) 0.23 Appraised Value $161.800 http://www.town.bamstable.ma.us/assessing/assess/displayparcel08map.asp?mappar=2300... 4/14/2008 TOWN OF BARNSTABLE LOCATION 2-4u ri d � SEWAGE#. VILLAGE cE�'ren'.`tL ASSESSOR'S MAP&PARCELAM INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY S'a8 LEACHING FACILITY:(type) `�ye.;.,C- (size) NO.OF BEDROOMS OWNER PERMIT DATE: . tx 1 (fit C COMPLIANCE DATE: %A7A `o$ 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 �l a)--/ No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: a PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01ppYication for Migozar bpotem Construction Vertu Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No.dus- L L1or\ �Y Owner's Nam,Address,and Tel.No. Assessor's Map/Parcel11 AM P 3 Installer's Name,Address,and Tel.No. Designer'pName,Address an 1.No. 271 - i a v. &Ic7-at 1) 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( � Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. Sign Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. '� Date Issued r--"'yr..`..,,,z.y, ._. F.. . .,�,• „`..•�,,,.....,`TM� ;�.,.r.:.,.,..y,.-•.,,.-v.-,....-.... ,� ..�-. ....�..y4....-�...r«--..u�-:w..,-� -.. �... ..- ..r'.'•y:c, vr. ,w .. ..- �, ! No. ,t`�"r.*'"""��, Fee i THE COMMONWEALTH-OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pprication for Tigpogal �§pgtem Congtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ' ete System ❑Individual Components P Y P Location Address or Lot No.a$- L.Q-J`CC.\ Owner's Na e,Address,and Tel.No. C ev.LGr����e... hn0, li-de7V Assessor's Map/Parcel P .3 Installer's Name,Address,and Tel.No. Designer' ame,Address an el.No. - /Zf 6 ,?•990Z Al833- 7 7 Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( X/Z Other Type of Building No.of Persons Showers( ) .Cafeteria( ) . Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title f Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 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. Sign .4 ° A Date Application Approved by Y11 � V �� Date Application Disapproved by: t Date for the following reasons 'A Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( Repaired ( ) Upgraded Abandoned( )by /'flC at 02,5-- 4 q .1 r e f ZL Ce„ro_,z,z /- has been const ucte i ordance with the provisions of Title 5 and the for Disposal System Construction Permit No.� 6 dated installer //I C.14 y 4,+t.,q— Designer a #bedrooms "Z, Approved design flow gp v Gr The issuance of this pe i s no be o sfrued as a guarantee that the system wdlfur cfon•�as/de,sigg ed. Date Inspect(r !/ Q ? — /� A ~" )r � No. r�! Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Digponl gtem Congtruction Permit Permission is hereby granted to Construct y ) Repair ( ) Upgrade ( ) Abandon ( ) System located at AS- 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 u/S�Ib`e om 1 ted within three years of the date of th' .�e ,i . Date 0 ) Approved by i Town of Barnstable o�'�HE Tpw �. Regulatory Services Thomas F. Geiler,Director s,►`Rxsi'As�e, a Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office:.508-862-4644 Fax: 508-790-6304 Installer &Designer Certification Form Date: ® t�1 3 Designer: (� _ Installer: L cv�12&0& Address: . Address: On 7DO19r, It 4 . was issued a perr.ait to install a at ) (installer) septic system at based on a designdrawn b (address} Y dated designer) certify that the septic system referenced above was installed substantially acc'�rd-' 'to ,die deli which may include minor approved-c x I Y han es PP g such as latcr�af reelocatzon of the 4sfribution box and/or septic tank. I cerW.Ihat the septic system referenced above was inst wd wit$'mai.o': r chars ' greater&MI 10 lateral reloeatibn o ge9: ('•e,f the SAS or any vertical eiooa ion of y componep} of the septti_-'.Ptem)but in.'accordance with State &.Local.Regilations. Plan revisioxA o� certified as-but"by designer tb'follow. er- taller s Signature) MASON r —i 0. Nt0.:066 sq ll TARAP� (D er s Signature) (Affix gner's Stathp Here) PLEASE RETURN TO BA STA&i,E"PUBLIC HEALTH DIVISIOl� CERTMr T OF COMPLIANCE �Vlil.l, NO ' E : SSgJED BOTHrX] OR - �,. BUST CA 2D ARE RECEYVED BY B 3 STALE P LI+C*, ; DV S 01� TIIAh' YOU ----»- Q:Flealt/Septic/Designer Certification Form Town of Barnstable B ine P# Department of Regulatory Services Public Health Division DateAMM (J O �u 200 Main Street Hyannis 2601 Dat, cheduled Time Fee Pd. Soil Suitability Assessment for Sewage'Disposal Performed By: �' " / C�`�,, Witnessed By: CDOW44­14 /�IL2N401 LOCATION& GENERAL INFORMATION Location Address C�U� "� ��1 Owner's Name Address Assessor's Map/Parcel: _1 3 ! Engineer's Nam ///,,o NEW CONSTRUCTION REPAIR Telephone# �? Land Use � / D es( ) Surface Stones11 Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well �J ft Drainage Way ft Property Line l y ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) :r Ln c', Map Parent material(geologic) �/'W Depth to Bedrock I o`er >. Depth to Groundwater. Standing Water in Hole: Weeping from Pit Face c� i Estimated Seasonal High Groundwater 15 — Z 0 DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soIl mottles: Depth to weeping from side of obs.hole: in, Groundwater Adjustment tt. Index Well# Reading Date: Index Well level Adj.factor...,.ae. Adj. rou dwater Level,� e PERCOLATION TEST bate Observation Hole# Time at 9" Depth of Perc w Time at 6" i Start Pre-soak Time @ I)/ Time(9"-6") End Pre-soak Rate Min./Inch O Site Suitability Assessment: Site Passed Site Failed: Ai Additional Testing Needed(Y/N) Original: Public Health Division Observation.Hole Data To Be Completed on-Back----------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTICPERCFORM.DOC 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# Z- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C itee Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ons' en Flood Insurance Rate Man: / Above 500 year flood boundary No_ Yes y Within 500 year boundary No jZ Within 100 year flood boundary No Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious mti nal exist in all areas observed throughout the :y area proposed for the soil absorption system? If not,what is the depth of naturally occurring pery ous material? Certification I certify that on /C/ (date)I have passed the soil evaluator examination approved by the Department of Enviro mental Protection and that the above analysis was performed by me consistent with . the required training,expertise and a pe 'e ce described in 310 CMR 15.017. ` Signatur ✓ Date Z 08 Q:4SEPTICVERCFORM.DOC S Town of Barnstable Barnstable �pSFIE raw y�P� �° Regulatory Services Department MRmmieaCp �+ BARNSrABLE, ` "AM Public Health Division mop i6g q, ,gym m ArEb MAC a, 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO January 2, 2008 Mary Catherine Eagan . 25 Laurel Road ;J Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 25 Laurel Road, Centerville MA was inspected on August 7, 2007 by Mark Polselli, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system FAILED under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool. Any portion of the SAS, cesspool or privy is below high ground water elevation. You are ordered to repair or replace the septic system within Sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE ARD OF HEALTH c ean, S., CH 7007 0710 0005 5820 7519 Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures\25 Laurel Road.doc 7007 071110005_ 5820_ 7519 ---_7007 0710 0005 5820 775519 r COMMOINWEE-�LTH OF M _ ..ASS ACI-II;SETTS kEi IJ I'IVE OFFICE OF E\r�ZRO�r � T�I 'F-AIRS DEPARi iE--,rl'oFATVIPOR+�+cE AF, zoc ®ter lYilGfd 0230 /'4ree ®3s TITTLE j OFFICIAL INSPECTION.FORM—NOT FOR VOLLT-N7A.RY ASSESSMENTS SUBSURFACE SENVAGE DISPOSAL SYSTEM. F'ORNj PART A CERTIFICATION Property Address: Owner's Name: Owner's Address: 02® qs, g pia �o�UI es �" .3.3/4{6 �� L��S� Date of Inspection: Name of Inspector: lease print Gar" ® �j `. Company Name Mailing Address: Telephone Numbe 77S —174eq CERTIFICATION STATEMENT I certify that I nave personally inspected the sewage disposal system at this address and that the for motion reported ~ below is true, accurate and complete as of the time of the inspection.The inspection-vas performed bawd on my-=3 training and experience in the proper fttuction and maintenance of on site sewage ` disposal systems.I arl�a DEP"0 approved system inspector pursuant to Section 15340 of Title 5(310 C-MR 15.M). Tiie system_ � C) rn Passes Condi'onally Passes -- ' ds Further Evaluation by the Local Approving Ali oritc F Inspector's Signature: Date: [he system inspector shall submut a copy-of this inspection repo z to the Approving Autbori�;(Board of Real or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design how of:0.00n gpd or greater,the inspector and the system owner shall submit the report to the appropriate �ion�i office o-the DEP.The original should be sent to the system owner and copies sent to the b ,if applicablz,and the appro� _ authority. u er V Notes and Comments ****This report only describes conditions at the lime of inspection and.under the conditions of use at€ilat conditions of use. time.This inspection does not address bow the system will perf©rllt in the fttttn a under the salve or different Ti;le 5 inspection.corm 6i15i2000 map t ' t Y Page 2 of I I OFFICIAL INSPECTION-FORM—NOT FOR VOLLT T_ARY ASSESSAIEtiTS SUBSURFACE SENVAGE DI6POSAr SYSTE-Nif nV5pIEC;Td0'%F©yZ�tf PART A CERTIFICATION(continued) Property Address: DIS 1-Gvere/ 4 d ��ai �* Owner: Ck Date of Inspech n: O Inspection Summary: Check A,B.C,D or E/ALWAYS complete all of Section D A.f System Passes: �1/ I have not found any information which indicates that any of the fidhue criteria described in 310 C_Y1R 15.303 or in 310 CbIR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B,�-/Systo m 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. Answer yes,no or not determined(Y,N,N-D)in the_for the following statemenis.If"not determined°'please explain. The septic tank is metal and over 20 years old*or the septic tank(v6edKT metal or not)is structurally Lmsound,exhibits substantial infiltration or exfdtration or tank failure is rent.System v,-ill pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Heali b. *A metal septic tank will pass inspection if it is structurally sound not leaking and if a Certificate of Coimliance indicating that the tank is less than 20 years old is available. STD explain: Observation of sewage backup or break out or high static water level in!he distribution box&ae to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(Rith approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced \-D explain: The system required pumping more than 4 times a year due to broken or obstructed p6els). —he pass inspection if(�zth approval of the Board of Health): broken pipe(s)are replaced obstruction is removed 'D explain: Tirlo� Tncrnrfin.. Fnr.... G;i r;nn,.,, Y Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUTI TARP ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL PART A / -CERTIFICATION(continued) Property Address: -Gore in Ret-,144 Owner: ti 4Q 91 Date of Inspec on: C. /Further Evaluation is Required by the Board of Health: /(1 Conditions exist which require ffinther evaluation by the Board of Health in order to deter=.— e if he sysem is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CiR 15303(1)(b)that the system is not functioning in a manner which will protect public heaMI. 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 wTtland or a salt marsh 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 enviromnnemt: 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 systern 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 colifonn bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5 pprm provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Pagd 4 of I I OFFICIAL INTSPECTION FO&M, -NOT FOR yOLUNTAR AssEss���Ts SLTBSL'RFACE SEWAGE DISPOSAL SVSTE_4i PART A CERTIFICATION(continued) Property Address: Zr 144.o ogG( .. Owner: lk�i C,4 PI Date of Inspec on- D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all ittspecrions: }backup of sewage into facili—ty or system coumonent due to overloaded or cloyed SAS of cesspool Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or ogged SAS or cesspool _ — Static liquid level in the distribution box above outlet invert due to an overloaded or-clogged SAS or /cesspool �Required quid depth in cesspool is less than 6"below invert or available volume is less�t%z day flow pumping more than 4 times in the last year NOT due to clogged or oasuu-ted e s .dumber times pumped t P� f ) portion of the SAS;cesspool or privy is below kLrh ground water elevation. L/.any portion of cesspool or grivy is within 100 feet of a surface water suppl or Wbutar y;o a surface water supply. �/'And portion of a cesspool or privy is within a Zone 1 of a public w-eL ��" ortion of a cesspool or privy is within 50 feet of a private water supply well. �Y Portion of a cesspool or privy is less than 100 feet but greater SQ feet from a private water ` PPIY well with no acceptable water quality analysis-j7'lds system passes if the wetl water saalysis, performed at a DEP cerfified labors#ore,for eoliform bacteria and volatile organic compam,db indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm;provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forDLI (Yes/?v o)The system fails.I have determined that one or more of the above failure criteria exis as described in 3 10 C-MR 15.303;therefore the s rstem 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 sys gpd. tem must serve a facility with a design now of 10.000W to 15.000 You must indicate either"yes"or"no"to each of the follewing: (The following criteria apply to large systems in addition to the criteria above) yes the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface dr,n ,g water spiv the system is located in a nitrogen sensitive area(Interim ti%ellhead Protection Area—M-P a Zone lI of a public water supply well .r 17 you have answered"yes"to an uestion in Section E the system is considered a si "yes"in Section D above the large system has failed.Tate owner or operator of any 1 Q scam it=rea?. Or=u'S�-%��C sinificant threat under Section E or fled under Section D shall¢ ` ar�2�k5 eu Co"�:fz :�2 's=0�. The system owner should contact the a p9mde the Pproprate regicnal office r slum t�ati corce op t DePai t!xnI. Page 5 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLViN ['ARY ASSESSNIENTS SUBSURFACE SEWAGE DISPOSAL PA�2T lB CRECELIS'I Property Address: (>ZS &t re -( v►4 rf/XM4 Owner: 'C'"I at h Date of Inspec ' n: Check if the following have been done.You must indicate"yes"_or"no"as to each of the fotiow ing: Yes �5umpirig information was provided by the owner,occupan� or Board of Health Were any of the system components pumped out in die previous two weeks? Hss the system received normal flows in the previous two week period? & Have large volumes of water been introduced to the system recently or as paw of this inspection? / !, Were as built plans of the system obtained and examined?(If they were not available note as\;`_A) Was the facility or duelling 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 b4affles or tees. material naI of construction,dimensions,depth of liquid,depth of sludge and depth of s� the facility owner(and occupants if different from ow-ter U-ided wit in_£ - Pm ormanon on the roper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no Existing in_forinabon. For example,a plan at the Board of health. Determined in the Feld(if any of the failure criteria related to Part C ' - is unacceptable) j310 CVLR 15.302(30is a:issue apox; rion of a-ice 3] T�rlo� tncr.ort�nn �'n,.rr !.!7 c.�nnn Page 6 of 11 OFFICIAL, I TSPECTTON FORM-NOT FOR VOLUW RY ASSESSNIEYFS SUBSURFACE SENVAC E DISPOSAL.S,ys€Er-Y IZiSPEC co Ft�R�F PART C SYSTEM IN ORIATIO Property Address: byAJ _ et " Owner: �Gr Vn Date of Inspec ' n• IR OR CO_INDITIONS RESIDENTIAL Number ofbedrooms(design):- Number of bedrooms(actual): DESIGN flow based on 310 CAR 15.203(for example: 110 gpd x-#of bedrooms): Number of current residents: �f Does residence have a garbage grinder(yes or no)- Is laundry on a separate sewage system(yes or no Eif yes separate inspection required] Laundry system inspected(yes or no):Piv n Seasonal use: (yes or o):_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): Last date of occupancy: CONLNIERCZAJ-lLN-DiTSI'RIAY. Type of establishment: Design flow(based on 310 CTMR 15 203): gpd Basis of design flow(seats/persons/sgfl etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTTI ER(describe): GENERAL LNItORNIATION Pumping Records / Source of information: Was system pumped as part of the inspection(3es or no): 1(,V If yes,volume pumped: gallons—How was quantity pumped determined? Reason for pumping: T V7PE OF S _Se "c tank, distribution box, soil absorption system Ingle cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records.if any) InnovativeiAlternative technology. Attach a copy of the current operation and maintenance cenzrac_ T,_ e obtained from system o-Amer) _Tiaht tank _Attach a copv of the DEP approval Other(describe): Approximate age of all components,date installed(if knox�n)and source of informaion: re se«°age odors detected when arrivinz at the site(yes or ro): T�tic � rn�na Page 7 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLU I-AP ASSESSAIIENTS SUBSURFACE SENVAGE DISPOSAL. SYSTE-m P.4,RT C SYSTEM E TORMATION (continued) Property Address: Ga Lv Ot f/- OVVner' �G� q H Date of Inspec . BL"ILDIIlG SEWER(locate on site plan) Depth below grade: Materials of construction:_cast iron _?0 PVC_other(explain): Distance from.private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:dz/oocate on site plan) Depth below grade: -Material of construction:_concrete metal_fiberglass__polyethylene other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or'no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 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: How were dimensions determined: Comments(on pumping recemm.--aidations,inlet and outlet tee or baffle condition,sauct:ual integrity.liquid levels as related to outlet invert, evidence of leakage,etc.): GREASE TRAPA (locate on site plan) Depth below grade:_ Material of corsnuction:_concrete_metal=tbe-glass relyethyle_ne other (explain): Dimensions: Scum thickness: Distance from tap of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition s7ucr al is te=riT liq. l as related to outlet invert. etzdence of leakage,etc.): Page 8 of 1 l OFFICIAL IINSPECTION FORM-NOT FOR VOLUNTARY ASSESS-Vf SUBSURFACE SEWAGE DISPOSAL SYSTE-M rls����p� g®ALE TS PART C SYSTEM INFORMATION(cowed) Property Address: �J ,47 t1 ral P.� Owner: G�f �� Date of IaisLpetr on: TIGHT or HOLDT\!.TANK:�it,rLti �t�e 71r[aed c`ti-e of in__zpection)(loca-e on site plan) Depth below grade: Material of construction: concrete meta_fiberglass__polyetkylene _o-d_,e_r(e�plain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in wo'hing order(yes or no): Date of last pumping: Coma ents(condition of alarm and float switches,etc.): DISTRIBURON 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 midence of solids carryover_any evidence of leakage into or out of box,etc.):. PUMP CHAibIBER: f(/ (Iocate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber;condition of pumps and appurtenances,-Lc): Tirio { Tncncr•t;nn �nrrr. �!}{�gllnn .. i Page of 1 I OFFI0-4I. INSPECTION FORM—,NOT FOR VOI.,L V'TA,RY ASSESS'-NrE-l-'S S UBS UPWAC'E SEWAGE DISPOSAL sys rE-Nj PART C SYSTEM[IIiTFORmATIO (continued) Property Address: 0?S �_ Owner: �or oc __ Date of Inspect n• Q SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number: leaching galleries,number: leaching trenches,number,Iength: 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,daW soil,condition of vegetation, etc.): 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: rr Depth of scum layer: Dimensions of cesspool:�px Materials ofcoustruction: Indication of groundwater inflow(yes or no): Corn entss note conditio�of soil,si�g;s of hydra lic failure,level of ponding,condition of veaeta�on etc.'): O v► f h L o {yf M� Zt ..T--- A VA A Gi ------------ PRIVY:&"Oocate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic fail u re.level of pondin�,cond;�io£ Tito 1 i.....a.t;nn Page'IO of I 1 OFFICI . 1 SPECTION FORIM-NOT FOR V OLUNTAR iSSESS_ IE �S SUBS_FACE SEWAGE DISPOSAL S'YSTE- Yti'SpE�i'YOZ CDr �g �:. P_�T C SYSTEM UNTOR:MATION(continued) Property address: ` JZat,re )g:�V Owner: Gj Date of Inspe on: '' U SKETCH OF SEWA DISPOSAL SYSTEM Provid a sketch of the: wage disposal system including ties to at least tv.o permmne m-reference landmarks or bent ks. Locate a.' ,'•ells within 100 feet.Locate where pu'lb c water supply enters the building. :. 4- Q F; 'Yr ,yR 1 ,�Y• y � rs IG #: T;tio C t^c*+ortinn �nnr 41. i Pace i I Of 11 ;x a� OF'FTICI ,tts SPECTION FORM—NOT FOR VOLUNTARY g ASSESSMENTS SUBS'..,'.., CE SEWAGE DISPOSAL s s!Tj:--,f PAIN C SYSTEM INF'ORNWATI N Property, Address: Q Owner. �Gr Date of Inspec 'on- 'rn' SITE EXAILL Slope t ' Surface wa et'r = C-4 Check cellar Shallow wells F // . Estimated depth to gra water feet Cps Please indicate(check)methods used to determine the high ground water elevation: s Obtained m sy;„ design plans on record-If checked,date of design plan- viewed: Ob ed site(aii` ng property/observation hole within 150 feet of SAS) pecked with Ioc and of health-explain: Checked with to }, xcavators,installers-(attach documentation) Accessed liSGS base-explain: You mast desc -be .... 'u established the high ground water elevation: r S , O Gt/ �- a k 411 Y� F 1 k IY ' ?t�G ftl[nGISI(�2'1 �/�YIYI 1HE Town of Barnstable OF 1p� Regulatory Services SjaB T ss. homas F. Geiler, Director Ma 9$AT�1639. g Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-8624644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Q}n 1( �X'.'(,..Ca��� R��L!N �3Ef�1�z`R�DV� V.4 uc T AU zv !_ _ _ MA _ y- - - _ e 25 I-AOPEL- i.. 1 r �► __ Ail 00 G._ Col+ COS 9� .41 AF I C i i 4 � � �aoX � Dl �'1 � ���� , a�oa - �Se y� ,� �� ,� ,�I�7��d ASSESSORS MAP : _ 2 TEST HOLE LOGS PARCEL : �j NOTES: FLOOD ZONE: hd0 /9 `� SO I L EVALUATOR : ✓1' V) C� ._.__. _. .-.__---- WITNESS : 0 �l I a A -y REFERENCE: t�1 z>� ��4W a � h /P4 #� DATE: q by 1) The installation shall comply with Title V and Town of Barnstable Board of Health Regulations. � - 'f� c�C � ��7 PERGOLA ION RATE: G Z i ► 2) The installer shall verify the location of utilities, sewer inverts and septic �' �C? �� � �j ,, 1 ►Z, components prior to installation and setting base elevations. TH- 1 TH-2 3) All gravity septic piping to be 4 inch Sch 40 PVC at 1/8"per foot. The first ' t two feet out of the d-box to the leaching shall be level. !t�� 77z, �o Z 4) This plan is not to be utilized for property line determination nor any other L�1'''` �U,,I yp 70 I D�M� �4ta,t�� purpose other than the proposed system installation. 5) All septic components must meet Tide V specifications. 2�s 6) Parking shall not be constructed over H10 septic components. Ju LOCATION MA P(�/ ) C55 ?j 7) The property is bounded by property corners and property lines. I�f 0, S tW 10 8) The property owner shall review design considerations to approve of total tt design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed approval of the design flow by the owner. 9) The existing leaching or cesspools shall be pumped and filled with material ►32/ �,�, lji2 per Title V abandonment procedures. Those within the proposed SAS shall r10110 otA be removed along with contaminated soil and replaced with clean washed ------------- -- sand per Title V specs. �. 10)System components to be 10 feet from water line. Sewer lines crossing the --, �,L -- t --- applicable =,- water line shall be sleeved with 4 inch SCH 40 PVC with ends routed if -- - - SEP ► 1 C S►' STEM DESIGN g . " ~p 11) If a garbage grinder exists it is to be removed and is the responsibility of the - pp`, n FLOW ES,T I MATE owner to ensure such. 12)The installer is to take caution in excavation around the gas line. ,►z,o5, BEDROOMS AT 11D GAL/DAY/BEDROOM -�-1DGAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling prior to the installation. SEPTIC TANK GAL/DAY x 2 DAYS - LW GAL ti 1 ' USE I5)D GALLON SEPTIC TANK b SOI A L 13SORPT I ON SYSTEM "'- ,t ;� 2� To SIDE AREA: Zx t ; . n 4 � 00o r - � BOTTOM AREA: (�•fj X c x �7�� `;, �� go '58 f 'aa - EPTI ,, SYSTEM SECT ION w & <r. �01 1 � N 4.. 2DiBO 37 �?. �J��13n ",, 3 -- �� � !C. .�.. �✓.N _ .51'Ul� r, 9 µ I�vao GAL 3�,�3 I __.. . _ _ �' ► Z -- SEPTIC TANK 3115 p , . — ( -:&TT-o b-r ILL. 25 !iF 0 0 0 S 1 TE AND SEWAGE PLAN - t�' M► LOCATION : <"i k PREPARED FOR j__e0eouP ,560D77C t SCALE: DAV I D B . MASON R.S DATE: 00g, ° DBC ENVIRONMEN)-AL DESIGNSTT z EAST SANDWICH . MA 3 DATE HEALTH AGENT ( SOS ) 833- 2 i 77 2