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Home My WebLink About0037 LONGBOAT DRIVE - Health 37 Longboat Drive Centerville .A= 193 - 158 No.2-15SLOR UPC 12534 smead.c®m • Made in USA OYC% * WW CWHED SOURCING V.^.h:"dS,Vw7Z'.aRA.vL6Rt3 TOWN OF BARNSTABLE LOCATION Rve.t SEWAGE# OS — 32 3 VILLAGE C� vc� ASSESSOR'S MAP&PARCEL J INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /000 /{ io rzillyr,i LEACHING FACILITY:(type) It) U S`o 0 (size) /2,& Y aS. NO.OF BEDROOMS 3 OWNER l�P� �u 13oeLeH S1,-e- �C PERMIT DATE:• /U Z ZU og COMPLIANCE DATE: d -1 - Zoo i Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility . NO 10 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 C� .i� prJ jel L C L .. .631 pi-z 29.s .a7.0 A3 sv,s g3 y1,u aq 3 3 g-O 3? No. � � t � Fee D THE COMMONWEALTH & MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplication for Noposal Opstem Construction 3permit Application for a Permit to Construct( ) Repair 4 Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3-7 Lo ncoo X. �-WZ vC Owner's Name,Address,and Tel.No. J4-eeb4 r r B«I e h Sir(( Assessor's Map/Parcel )5-? (04A0 Installer's Name,Address,and Tel.No. Lakqt0;". ek4.?yg Designer's Name,Address,and Tel.No. Cw3 I-. 5v_f u Po w"7 3 djZ A-W(.A Type of Building: Dwelling No.of Bedrooms Lot Size _�_5�� Z o�- sq.ft. Garbage Grinder( ) Other Type of Building 64 No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) .3G gpd Design flow provided 341 gpd Plan Date g—i et-La Number of sheets ( Revision Date Title '3 '1 t Size of Septic Tank 1000 Type of S.A.S. 2- s� vvc L.c. 4-to 5)'u-41 Description of Soil Nature of Repairs or Alterations(Answer when applicable) exss Tn,.,/L Date last inspected: 70c 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 Healt . Si d Date Application Approved Date/0 `,'�,Zo Application Disapproved by Date for the following reasons Permit No. 'Q�cc ` 3 3 Date Issued © E�- No. (J '_ �, ... ►i _` ' - -e , Fee QQ ' THE COMMONIN'EALTt `OF MASSACHUSETTS Entered in compute PUBLIC HEALTH DIVISION -TOWN;OF BARNSTABLE, MASSACHUSETTS Yes application for Misposal 6pstent Construction 3permit Application for a Permit to Construct( ) Repair Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No.3-7 lon Owners Name,Address and Tel.No.• ��AC b<<vC �/� /,.� Ner+�RrT ��2nS'�(( Assessor's Map/Parcel J5 (Otl o , Installer's Name,Address,and Tel.No.LAQc,a,&a Designer's Name,Address,and Tel.No. c:i%Ie P-9-. .g Cl2 Jj /L(d-cvlq Type of Building: Dwelling No.of Bedrooms Lot Size 5�, Z O 4 sq.ft. Garbage Grinder( ) Other Type of Building 5 h,�L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3.30 gpd Design flow provided 3y 197 gpd Plan Date g—t e(-Lo y g Number of sheets ( Revision Date Title ' 3 '1 G.%P-r Size of Septic Tank (17 Go 42)�js A-LA Type of S.A.S.�2�S-oo !�Vvc L,C. Description of Soil Nature of Repairs or Alterations(Answer when applicable) t✓ICES� � ,p L TlA vdl 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 •.,,ate x.,„, Compliance has been issued by this Boat o• Heal "*,< S ed Date Application Approved Date Application Disapproved by Date for the following reasons Permit No. [S 00 q ' J c�j N Date Issued- -------------------------------------------- - -- - --------------- - --=-- - ----------° THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Comprian e THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) RepairedV) Upgraded( ) Abandoned( )by �d4 �^Ldi'1r►Q•t�[) (_l ` �' ,. at 31 4.t> yoA-T _h Ui '�� has been constructed in accordance l with the provisions of Title 5 and he for Disposal System Construction Permit Nq,9W�,�lated /0 /5 l Installer C�1.Q, i L� Le , 't( ✓t5�) Designer 6 M3�< #bedrooms 3 Approved design floe gpd The issuance of this permit shall not be construed as a guarantee that the system will function as deli Date 10 -7 - y cl Inspector c No. ^3 c�—_7 ., Fee ! 0 6f THE COMMONWEALTH OF MASSACHUSETTS y PUBLIC HEALTH DIVISION BARNSTABLE,MASSACHUSETTS )Disposal Opstetn Construction J)Prmit Permission is hereby granted to Construct( ) RepaiV, Upgrade( ) Abandon( ) System located at 3-7 "f$10 oA-N D K u tc Q%,A y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i_ Title�5 and the following local provisions or special conditions. Provided:Construction must be om leted within three years of the date of th\permit Date Approved`by TRANS: NO.: CITY/TOWN: APPLICANT: ADDRESS: 3-1 L ons% r -Dt',\.)C DESIGN FLOW: �— gpd REVIEWED BY: DATE: N/A OK NO GENERAL r Nz Legal boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot,tax parcel number and lot number noted on plan [310 CMR 15.220(4)(u)] Locus Provided [310 CMR 15.2204(t)] Plan proper scale? (1"=40' for plot plans, 1"=20' or fewer for components) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a) for ✓ upgrades]- if not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) 1310 CMR 15.220(4)(d)] Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas. [310 CMR 15.220(4)(e)] System Calculations [310 CMR 15.220(4)(f)] daily flow septic tank capacity(required and provided) soil absorption system(required and provided) whether system designed for garbage grinder North arrow [310 CMR 15.220(4)(g)] Existing and proposed contours [310 CMR 15.220(4)(g)] o/ Location and log of deep observation holes (existing grade el. on ✓ each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310 CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] Certification statement by Soil Evaluator [310 CMR 15.220(4)0)] Observed and Adjusted groundwater(method for adjustment given or indicated) [310 CMR 15.103(3) and 310 CMR 15.220(4)(n)] Address �3 S� Sheet 1 of 7 N/A OK NO Location of every water supply,public and private, [310 CMR 15.220(4)(k)] within 400 feet of the proposed system location in the case / of surface water supplies and gravel packed public water supply ✓ within 250 feet of the proposed system location in the case within 150 feet of the proposed system location in the case / of private water supply wells Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins t/ located within 50 ft. [310 CMR 15.220(4)(1)] Water lines and other subsurface utilities located [310 CMR / 15.220(4)(m)] (if water line cross see 310 CMR 15.21l(1)[1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)] Stamp of designer [310 CMR 15.220(1) and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2) or as ✓ approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] Test hole adequate to demonstrate four feet of suitable material? [310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? 1310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)(q)] Materials specifications noted? various sections of 310 CMR p [ 15.000] System components not> 36" deep (unless Local Upgrade Approval or LUA requested) [310 CMR 15.405(1(b)] Address ! 93�S� Sheet 2 of 7 N/A OK NO fi�� xyr� SEPTTC;TANK r x IINO �M�1"1;.. � � ,,11 K.;,� .,�, ., .��4r m: s,�2.: ..,a,.-�..n. i.a.,�;x, �.,.,R Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line [310 CMR 15.227(6)] Outlet tee 14" or 14" + 5" per foot for increase ft depth [310 CMR 15.227(6)] Outlet tee with gas baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15228(1)] Separation between inlet and outlet tees (no less than liquid / depth) [310 CMR 15.227(2)] Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for upgrades under LUA [310 CMR 15.405(1)(k)] Minimum cover 9" (Tanks buried more than 9" must have risers on all openings and on the d-box) [310 CMR 15.2228(1) and 310 CMR 15.232(3)(f)] Three access covers (inlet and outlet must be 20" or greater) - . / middle access at least 8" (by 7/07) [310 CMR 15.228(2)] v Access to within 6 of grade - one port for systems.<1000gpd, ✓ two for systems >1000 gpd [310 CMR 15.228(2)] All at-grade covers secured to unauthorized access? [310 CMR / 15.228(2)] �/ > 10 ft from building foundation [310 CMR 15.211(1)] Buoyancy calculation Required/Done [310 CMR 15221(8)] H-20 Where appropriate? [310 CMR 15.226(3)] Setbacks from resources [310 CMR 15.211] � ^X�'7r°p Fv af'. ,� `` S:.' —+ 3 ,+�.. r v ,lvtis 1VIulti'.Compartment auks u , Y r f Required when other than single-family dwelling or flow>1000 gpd [310 CMR 15223(1)(b)] First compartment 200% daily flow; Second compartment 100% daily flow [310 CMR 15.224(2) and(3)] "U" pipe through or over baffle, outlet of each compartment with j gas baffle or approved filter [310 CMR 15.224(4)] V Address / Sheet 3 of 7 N/A OK NO BiTILDINGEWERIYDOHERPTPINGn � � ;;;Y , Located at least ten feet from any water line? [310 CMR 15.222(2)] Disposal piping at least 18" below water line(when water and @/ sewer cross, see 310 CMR 15.211(1)[1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks specified in force mains? 310 CMR 15.221(6)(c)] Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable / [310 CMR 15.222(6)] Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.251(9) and 310 CMR 15.252(2)(c)] Siphon problem/(leachfield below pump chamber) Endcaps or vent manifold specified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe / types allowed) wDxST'.RIFB,�.s.�ION,:BQX��:.��.��,��k��,��• ,�� z��=r�-��z��, a� <.��#:��.L=.� ,..a" �i.,��. a�w..,.x„ i,..��;r s Stable compacted base [310 CMR 15.221(2) and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided? (when pressure sewer to d-box or steep pitch of gravity sewer) [310 CMR 15.323(3)(a)] Riser if deeper than 9" [310 CMR 15.232(3)(f)] Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] Watertight cover if<2000gpd);waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] ��,�, PUlVIPCHAMBERS � § ps , Capacity(emergency storage above working--design flow)? [310 CMR 231(2)] Proper setbacks [310 CMR 15.211 (same as septic tanks)] Watertight 20-in minium access manhole at least 20" MUST BE TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps specified? Exceeds two units must have two pumps operating in lead-lag mode. [310 CMR 15.231(6) and(8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed? Provided? [310 CMR 15.221(8)] Address l 3 s8 Sheet 4 of 7 N/A OK NO $ 3 a s °'x r �.e+r P"4o' S � ��,�'4n l,. r�'�Z'��_.b 'fist '� ruz� �i�s r'' n ` ai" k, ��a,e•*. Calculations correct? 4 feet of naturally occurring material demonstrated? [310 CMR 15.240(1)] Required separation to groundwater? [310 CMR 15.212)] ✓ Aggregate specified as double washed [310 CMR 15.247(2)] ✓ System Venting required/provided? (system under driveway or / >36" deep) [310 CMR 15.241] ✓ Inspection ports specified and within 3"final grade? [310 CMR 15.240(13)] Breakout requirements met? (No violation of breakout elevation within 15 ft of SAS unless barrier) [310 CMR 15.211(1)[4] and Guidance Document] Chambers and Gal. in trench configuration supplied with inlet every 20 ft. [310 CMR 15.253(6)] Each structure with one inspection manhole (if>2000 gpd must be to grade) [310 CMR 15.253(2)] Aggregate I' minimum- 4'maximum. [310 CMR 15.253(1)(b)] r/ 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 sq. ft. [310 CMR 15.253(6)] -TREY HES3i0 Cf � rt ...A. _ mzr .a.u �&"r.'. .f+8ec3-.: ..� Width 2'minimum T maximum [3.10 CMR 15.251(1)(b)] 100 feet- maximum length [310 CMR 15.251(1)(a)] Minimum separation 2x effective depth or width whichever greater(3x if reserve between trenches) [310 CMR 251(1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] BED SAS (1VIaximum site of>bed orrfield5000 "Sy _ ' minimum 2 distribution lines [310 CMR 15.252(2)(a)] Maximum separation between lines 6' [310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6 minimum, 12" maximum. [310 CMR 15.252(2)(g)] Separation between beds 10'minimum. [310 CMR 15.252(2)(0] Bottom area used in calculations only[310 CMR 15.252(2)(i)] Address Sheet 5 of 7 N/A ' OK NO i tLANTNV®L'�E �, �' 593 Pressure Dosed System ? Provided pump and piping calculations as required [310 CMR 15.220(4)(r)] Pressure dosing required on all systems >2000gpd or alternative systems under remedial approval [310 CMR 15.254(2) and I/A Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] Inspections once per year(systems<2000 gpd) or quarterly f (>2000gpd) good to note on plan [310 CMR 15.254(2)(d)] Construction in fill -Did the plan specify that the fill shall meet the specification of 310 CMR 15.255(3)? Impervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by / designer [310 CMR 15.255(2)(b)] V Retaining wall must be designed by Registered Professional / Engineer [310 CMR 15.255(2)(a)] V Side slope not exceed 3:1 ? [310 CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2) and Guidance Document] At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Check DEP Approval letters for credits and design conditions If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP Approval Conditions? Is there a note on the plan regarding the requirement for perpetual maintenance agreement? Any alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? Has applicant submitted a copy of a maintenance Are the variances listed on the plan? [310 CMR 15.220 (4)(q)] RLS Stamp necessary on plan if a component is within five feet of property line [310 CMR 15.412(4)] New construction or increased flow proposed [Refer to 310 CMR 15.414] Address l 95 A-9 Sheet 6 of 7 N/A OK NO r xx r"✓ '+ � i � � �: � .f,,".x.FF 9S�..EW r'^� {a x � � n 5 �� .�`t. #s rxaar�^r„- '�lw"��f{s .5.,;^ g£^� a L z. ,,k .�3�`.s,x .4., s,�>s.2 a_,✓�aYr�aP'r�`�.u,».a.:. ,�. s.,a�5��,Y.�.,e:- -k.�.� <�,..�Za >r... ,s�„ ..6,.». ,ems,� r,s Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216 - also refer to Policy regarding upgrades of such V existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(1)] V ," LLlZ71eUT�lS 4r4✓'i,;,r eh�i€x',�.. ."?��'�� u„"��. .�FG'� r��fo.m#� .a'.,z<;sr � � �� Pumping to septic tank ? [ 310 CMR 15.229] Shared System [310 CMR 15.290] Address 93 ®�� Sheet 7 of 7 TOWN OF BAPSTABLE LOCATION � boccv V SEWAGE # VILLAGE \ 0\KA— ASSESSOR'S MAP & INSTALLER'S NAME&PHONE NO. / \ /a AMA SEPTIC TANK CAPACITY b�U LEACHING FACILITY: (type)_ eU�t (size) NO.OF BEDROOMS M BUILDER OR OWNER PERMITDATE: 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 �C a A o ed A Oo I 4e3�1 '='� qN ?A 1 V v t3® �l O .0 G For delivery, O • A U E a �2601 t17 Postage $ O f1.1 Certified Fee O COPos}�rk Return Receipt Fee p (Endorsement Required) e 0 Restricted Delivery Fee J� CO 0 (Endorsement Required) Q a V � Total Postage&Fees s ri Sent To CEI r.��y.__.��i 05_!e O or PO Box No. City,State,ZIP+ 'J, ;1 0 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry.-- PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 aFT�r� Town of BarnstableBarnstable Regulatory Services- Department ��aCdq Z BA.RNSTMSLFF MASS., ,�` Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008604 8/18/2009 Herbert Bondinsiek 58 Loomis Lane Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 37 Longboat Drive, Centerville MA was last inspected on June 18, 2009 by Mark Polselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. 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. Xs7 . ER OF HE BOARD OF HEALTH McKean, R.S., C O Agent of the Board of Health Commonwealth of Massachusetts I Mz, Title 5 Official Inspection Form =1 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L Lo Arc— `. Property Address // Ae."40" Cl nS'ie-lr-'� Owner Owner's Name information is Cjevl 4p y,/le /' Qd 63� fo $ O required for every page. City/Town State Zip Code Date of:nsoe Pion 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 -Y�'I►" I ¢I computer,use 1. . Inspector: only the y b key to move our cursor-do not Name of Inspectoruse key.the return Company Name L ro de 1 ff Company Address�Gs�4 a w, �i� fd City/Town r0� State Zip Code Telephone Num er 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 mspealon.,she in4ec ion.: was performed based on my training and experience in the proper function and fxjaintenanc�of sl e E. sewage disposal systems. I am a DEP approved system inspector pursuant to Sectiora�15.3z7of Title 5 (310 CMR 15.000). The system: r ❑ Passes '` ❑ Conditionally Passes Fads ° ' (❑ Needs Further Evaluation by the Local Approving Authority /� a! rn Inspe is 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 cr has a design flow of 10,000 gpd or greater, the inspector and the system ovmer shall submit the report to.the appropriate regional office of the DEP. The original should be sent to the systems. 0,,%iner 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. a /o t5ins aloe Title 5 Oncia+lnso=_c5on Forcn:s!a`aca Szv. Ois es_,S >;.-:• - - _. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address ��P t/l�i�l✓ Owner Owner's Name information is C Ili /V c7d-63a 611 8 p� required for (///! every page. City/Town State Zip Code Date Inspection B. Certification. (cont.) N 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: IS 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. �l 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 eAltration or tank failure is imminent. Systen^tt will pass inspection if the existing tank is replaced with a complying septic tank as approved by t1he 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): I$ t5ins•09/08 - Tiite 5 ofidai tnSDey ion Fan:: ---o j Commonwealth of Massachusetts Title 5 Official Inspection Form • !i Subsurface Sewage Disposal System Form -Not for Voluntary Assessments VAR Property Address l Owner Owner's Name /_ // r information is CeN7(,f(////� �/� �a6zz Yj 3 O, required for every page. CityfTown State Zip Code Date or spec::on B. Certification (cunt.) B) System Conditionally Passes (cont.): Il ❑ 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 .^fetiand or a sa+f,mars;; t5ins•oqm Tide 5 Offidai inspection Form:Sutss c=S :-_=?ic_,-_ c _;—•n a - IS Commonwealth of Massachusetts Title 5 Official Inspection Form I" Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ��—(W AK—!` — Property Address Owner Owner's Name //,-, �l information is required for �N 4,,v.,Ile �� D�6a�C every page. City/Town State Zip Code Da# of Ins4ection 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. ir ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public:eater 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 lg 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: li D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes o n Backup of sewage into facility or system component due to overloaded or `J clogged SAS or cesspool ❑ Discharge or ponding of effluent to the surface of the Ground or surface waters u due to an overloaded or clogged SAS or cesspool �' I ❑ Static liquid level in the distribution box above outlet invert due to an u LE or clogged SAS or cesspool ❑ Liquid depth in cesspool is less than 6"below invert or available voUne Is less than %day flow t5ins•moa .Title 5 OffiWa?Insoee5on Fc m-subs,.=>ce s2wace sv:> 7 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address � / oW Pq se Owner Owner's Name �/ }information is required for �e Ile, �/T �a26 6 / O/p �/' t/f�! every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) I¢. Yes No ❑ LR Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ak-111' Any portion of the SAS, cesspool or privy is below high ground water elevation. El lsd'^ / Any portion of cesspool or privy is within 100 feet of a surface water suppiy or tributary to a surface water supply. ❑ [;/ Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Q� 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 I I ❑ ❑ the system is.within 200 feet of a tributary to a surface drinking water suppiy E] Elthe 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 signlfican-i 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 s!Waif upgrade he system in accordance with 310 CMR 15.304. The system owner should contact the aoroor;ae regional office of the Department. i5ins•09/08 Title 5 Official lnspeciion Farr^:,:Sij—h I Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments <, �� 13 �1 .boy &-3� - -- I Property Address i` 4 C$N S—/ e- Owner Owner's Name / 1 information is Cep 4,- Ile— �� oL fi�d 8 0� required for every page. City/Town State Zip Code Date of irlspection C. Checklist Check if the following have been done. You must indicate"yes' or"no"as to each of the following: Yes o " ❑ 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 par, 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) j310 CMR 15.302(5)1 D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): 330 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x=of bedrooms). t5ins•osioe s bsu _� __ y Ti;e 5 oficiai inspecSon Torn: r_^=S2v;aca ;scow° =_.en.�_._- -7 Commonwealth of Massachusetts R Title 5 Official Inspection Form ice':; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owner's Name q information is Cep 4.,yr Ile- required for every page. City/Town State Zip Code Date of Ins,ectie^ D. System Information Description: // V O e�G!(ova y. /0 eta A t Number of current residents: �l Does residence have a garbage grinder? ❑ YesNo Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Laundry system inspected? ❑ Yes -� Seasonal use? ;J YesNo Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes i Last date of occupancy: Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gp.d Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? Yes No Industrial waste holding tank present? Yes No f Non-sanitary waste discharged to the Title 5 system? ? `'es 71 No Water meter readings, if available: t5ins•o9/o8 - iitle Commonwealth of Massachusetts Q ,2� Title 5 Official Inspection Form ;j Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 12 Property Address do Owmer Owner's Name /' information is CQ., 4,144e A/f . 0).6 reouired for 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 F—Z'�o I . If yes, volume pumped: gallons II How was quantity pumped determined? Reason for pumping: TyZ71 Septic tank, distribution box, soil absorption system ❑ Single cesspooi ❑ 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 U Tight tank. Attach a copy of the DEP approval. ❑. Other(describe): t5ins-09,108 Title 5 official Inspection Form:Su^.su,=ace Sevece D-os '.Sys i_m•Fs_ a i 7 l Commonwealth of Massachusetts Title 5 Official, Inspection Form U; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address Owner Owners Name // /� O information is Q1 _)6 required for / , (/� every page. City/Town State Zip Code Date of inspe lion D. System Information.(cont.) Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes 5:1-_�o Building Sewer (locate on site plan): Depth below grade: feet Material of construction: i ❑ 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: feet Material of onstruction: I.. concrete ❑ ❑I metal ❑fiberglass polyethylene 1 1 other(exaiain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ± ! Yes ❑I !,Jo Dimensions: X� Sludge depth: t5ins•09/08 Title 5 Official Lnc0=coon Forth:Sube : _2 v=e= i,, ,=i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y vJ 6 0� Property Address /� 1Jo -Ile P7-06 l✓ Owner Owner's Name information is le— required for every page. City/Town State Zip Code Date of nspection D. System Information (cont.) Septic Tank (cont.) e ll c? Distance from top of sludge to bottom of outlet tee or baffle 9 Scum thickness a-3 r " i/ .rt 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 recommendations, inlet and outlet tee or baffle condition: structural integrity; liouid levels as related to outlet invert, evidence of leakage, etc.)-. N Wt +n ✓tee C Q T / !v`9� O� ��✓ CoN�/.0&7 A-0 Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other (explain): Dimensions: Scum thickness i I 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 t5irs•09108 'nue 5 03cial in�oecu on�errn:Sussvr:"a S=•.._c= _-. ._.. . 7 _ Commonwealth of Massachusetts iW Title 5 Official Inspection Form - i�i Subsurface Sewage Disposal System/Form Not for Voluntary Assessrrients `. Property Address J gp Owner Owner's Name t information is Ce-H. required for � every page. CitY/To`M'i State Zip Code Date of Insl5ectUon 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 Elmetal ❑fiberglass Elpolyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: . Alarm in working order: V Yes ! No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): r f *Attach copy of current pumping contract (required). Is copy attached? 7. Yes 1-7 tic t5ins•ows Title 5 Omdal fnspe_i'On Fc--:Subsu,f_ce S-cw2 e =_sni Commonwealth of Massachusetts t.W IMFTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments Property Address C l/yo J e Owner Owner's Name information is CQ µ ✓!/�`/� �ot b 3� 6 �� required for — every page. City/Town State Zip Code Date el Insp4ctuion 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.): AD ©G� Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes LJ No Alarms in working order: 11 Yes ❑ No �G 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: t5ins•09/08 Title 5 Orndal Inseec5on Forrm: Commonwealth of Massachusetts a Q'c Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments C72 G orgy bo Ow: a 74 Property Address / o C ,I ,-i 2 Owner Owner's Name /� information is Ce µ fG V,//,jQ�— required for every page. City/Town State Zip Code Date o, Insp tion D. System Information (cont.) Type: X " leaching pits number: � . ❑ leaching chambers number: leaching galleries number: 7 leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativefalternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): /�N /N Q / Cesspools (cesspool must be pumped as part of inspection)(locate on site Plan).- Number and configuration I Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer I I� Dimensions of cesspool Materials of construction Indication of groundwater inflow I l Yes I 11 No t5ins•09108 Title 5 Offida1 Insceceon re-n:Subsurface Se•Av=c=7s Dos?f Sys e:-•P=c=73 o t7 Commonwealth of Massachusetts Title 5 Official Inspection Form id . . 2 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address �e � denSi�� Owner Owner's Name Q information is CQ� �ED Ile— O d 7,z 4/ 1 e O / required for every page. City/Town State Zip Code Date of lnsp ction D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation: etc.): is Privy (locate on site plan): Materials of construction: Dimensions Depth of solids i Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i� t5ins•09/o8 Tile 5 Ofcial Insoeotion Forrru Subs:mac=Sa _= ^_ ,Sysie:-.=__ _ __._._:-.i Commonwealth of Massachusetts 1" Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Loh deC-;� - - Property Address 1 . Owner Owner's Name information is Cew �f✓I//� /"!�L aQ 6 ,��- G�� v� required for every page. City/Town State Zip Code Date of Inspecton 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 p water supply enters the building. Check one of the boxes below. hand-sketch in the area below ❑ drawing attached separately i j AH IN I i l I � lYd, a 9 97 - pz.� i i t5ins•o9m Tile 5 Ornaai inspection Form.:Subsu; Se--ace Js, ;�f Sr_:=... r c_:;? Commonwealth of Massachusetts r Title 5 Official Inspection Form � ) Subsurface Sewage Disposal System Form -Not for Voluntary Assessments =A j Property Address /2O Owner Owner's Name information is C 14"`o required for eH — every page. City/Town State Zip Code Date or Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells ^� Estimated depth to high ground water: feet Please Indic all methods used to determine the high ground water elevation: Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) Q/Checked with local Board of Health -explain: _ ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: li You must describe how you established the high ground water elevation: Cl0tin It., V4" Before filing this Inspection Report, please see Report Completeness Checklist on next page. I� t5irs•09/OS Title 5 Ofa7 Inspection Form:subs:.ice se:pc,_ __Ot- i t Commonwealth of Massachusetts Title 5 Official Inspection Form '= _z Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Property Address o it,se�i Owner Owner's Name information is Cc WV 4vv7`lam required for Aq every page. City/Town State Zip Code Date of lnspectien E. Report Completeness Checklist ff Inspection Summary: A, B, C, D, or E checked Inspection Summaty D (System Failure Criteria Applicable to All Systems) completed Syst Information - Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file ii t5ins•09/08 Tite 5 Official Inspection Form:Subsucace Sev.^ee 0rsxsa?S:rsf Town of Barnstable p# a SOS o Department of Health,Safety,and Environmental Services ,BIKE Public Health Division Date 367 Main Street,Hyannis MA 02601 • BARNSTABLE, Date Scheduled Time ��( Fee Pd 1,(� Soil Suitability Assessment for Sewage Disposal Performed By: 5T�?��+--� /-fNA-rAr�j (7� Witnessed By:-DOG- L-. tQCA TTQT& +G1 AL Il1FORlY1�4`P (Ql�I Location Address Owner's Name 1-164-661— �� Address Assessor's Map/Parcel: 13 j�S Engineer's Name /g NEW CONSTRUCTION REPAIR ✓ Telephone# SO"3 i3Z Land Use t-3 Slopes(9/0) 7m Surface Stones /Ja Distances from: Open Water Body '— ft .Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line lU ft Other ft SKETCH: (Street name,dimensions of lot,exa t locations of test holes&pere tests,locate wetlands in proximity to holes) c_ ZE! ' CJ Parent material(geologic)Dui Depth to Bedrock 24'a4- Depth to Groundwater: Standing Water in Hole: /-jig- Weeping from Pit Face ..C.'LA iEstimaie4 Seasunal i-iigh Groundwater ,U/ A DETJEJlYATION FiOR SEASONAL HIH'RTER T BLS Method Used /V ,F(- Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs:hole: in. Groundwater Adjustment ft, Index Well#__-. ._ Reading Date:..^_ Index Well Jevel.._._ Adj.factor Adj.Groundwater Level 777 PRCOLA' ' +C1N TT Aatc � �r TtAte � ....: Observation / Hole# I Time at 9" 3 P�h� Depth of Pere ��j�i Time at6" -]r-i.tdnSct Start Pre-soak Time @ 0-r"' Time(9"-6") •+psi qu SL-- End Pre-soak Rate Min./Inch GZ Site Suitability Assessment: Site Passed C/ Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Baclt Copy: Applicant Depth from Soil Horizon Soil Texture Soil Color ^ Surface(in.) Soil Other (USDA) (Munsell) Mottling (Structure,Stones,Boulderes. ns's n % 3Z 0 DEEP.OIiSERYATI01�1 OLE LOG Hale# :.Depth from Soil Horizon Soil Texture ^^—^ Surface(in.) Soil Color Soil Other I (USDA) (Munsell)" Mottling (Structure,Stones,Boulderes. C s'st c ° v w ZS IIEF OSEVA ' fJ1�1 IQL IO IQIe . Depth from Soil Horizon Soil Texture Soil Color Surface(in.) (USDA) Soil Other (Munsell) Mottling (Structure,Stones,Boulderes. C i ' ency.%Gr v 1 ll�+EP OBERYE�TIQ�F HO ,E I i.00 role Depth from • P Soil Horizon . Soil Texture Soil Color Soil Other Surface(ill,) (USDA ) (Munsell) Mottling (Structure,Stones,Boulderes. Consis enc °/ Gr ve I Flood Insurance Rate Map• Above 500 year flood boundary No_ Yes Within 500 year boundary No k Yes Within 100 year flood boundary No_k Yes Denth of Naturally Occurrint?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? Certification I certify that on !i /� S (date)I have passed the soil evaluator examir}ation approved by the Department of Enviro ental Protection and that the above analysis was performed by me consistent with the required training, x ertise and experience described in 310 CMR 15.017, Signature Date YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: I� Fill in please: VIA V1 L APPLICANT'S _ YOUR NAME/S: ,1 11A So us Cy-- INNI YOUR HOME ADDRESS: � � IW 33)S c 4I- 2 s7V 'k" TELEPHONE # Home Telephone Number O NAME OF CORPORATION: NAME OF NEW BUSINESS Rni 1P CZ TYPE OF BUSINESS INC IS THIS A HOME OCCUPATION? YES NO ADDRESS OF BUSINESS �n�er��I MAP/PARCEL NUMBER 1 �J� (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM Abb R'S OFF This individu I infor d f ny er t requirements tha ertain to this type of business. Aut o ized Sig atu * C M NTS: CA 4 2. OARD OF HEALTH This individual has been inf W the permit requirement that pertain to this type of business. � (� utho. i 'd Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: rtr G :�>co 3;0 _41 b -V S a � J i A 3 i � �' �-5 � � � o r to y� �� .� '� .. I I � � �� 1 � � ( (/ � ln� © � _. ._._. _.__ � . �.._.-. _ __________y.._�_.______...--_--_..____.___________ ____ �; ,� �� .. ;1 \� 1 i � � �� ! f � --) t �`� � ,' � ', � F _ `1 PLACE STICKER .•. i E RETURN ADILRI�S!�,ILO P of„ Town of Barnstable P� Public Health Division RARNSTARI.E. • Q MASS. g. 200 Main Street •� ,�. ,. �! �p '639. 0 Q rP �f0.no�N. Hyannis,MA 02601 v BOWES r° • 02 1A 540 0004606238 � L 2 9 7008 1830 0002 0500 8789 MAILED FROM ZIP CODE 02601 RETURN RECEIPT RE(�UtST, ED Herbert Bondinsiek � .1 37 Longboat Drive Centerville, r . ,. 1vx T T�j E"P 1.T2ja1 `t°�i �E 1•,4�E"}� • C3'm'�L�3°��sf3�e�s 3S�)))))S)�>If)SSS)1))))fI)S))f�S!))fSl))))f):II{)>>�S))>1f)IfS �, SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature Item 4 if Restricted Delivery is desired. ❑Agent X ■ Print your name and address on the reverse ❑Addressee , so that we can return the card to you. B. Received by(Printed 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 440ar{ or��,nsi boM =j>o rV1�I e W 4 o010 2) `� 3. Se Ice Type Certified Mali ❑Express Mail ❑ Registered ❑Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes j 2. Article Number 7008 1830 0002 0500 8789�� j (transfer from service label) i ti PS Form 3811,February 2004 Domestic Return Receipt 1 o2sss-o2-M-1 s4o Town of Barnstable Barnstable Regulatory Services Department ca 1 MASS. Public Health Division a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 70081830000205008789 7/16/2009 Herbert Bondinsiek 37 Longboat Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system locatedd k37 Longboat Drive, Centerville MA was last inspected on June,18, 2009 by Mark jP6lselli, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Backup of sewage into facility or system component due to an overloaded or clogged SAS. 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 OARD OF HEALTH l a t 7 J,C !. fyd6�� :' i�ilf Tl i ; ,,r 4C f 'to r cKean, R S , CHO _`:� U t t s _( ,' t r.Ei.< s_Ff, t•. )ij..�. �'.,f.�. ..t.�.,r �,�� -. .-.. .�•; 2 . ,4 �) :�.i_,.. _. Agent of the Board of Health TOWN OF BARNSTABLE 01 UNDERGROUND FUEL AND CHEMICAL STORAGE SYSTEM / NAME D V I ) 1?4= 4 L 7 Y ' R u S ) ADDRESS '�? 7 LO N7 9 0/a ?- LR VILLAGE LOCATION OF TANKS: CAPACITY: TYPE OF FUEL AGE: TYPE: OR CHEMICAL (Give same information for any additional tanks on reverse side of card) DATE OF PURCHASE OF EACH: 1. 2. 3. 4. DATE OF FIRE DEPARTMENT PERMIT: TESTING CERTIFICATION SUBMITTED: PASSED DID NOT PASS APP1OT. BD Barnstaolo Consosvation COwlesion Signed to Town of Barnstable 'THE'°'� Regulatory -Services Thomas F. Geiler,Director • 13MMSTnsLE, 9�A '"S. ,0� Public Health Division TFD N1Pr A Thomas McKean,Director 200.Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form 9 Date: /ft y v i Sewage Permit# 3 Assessor's Map\Parcel /9 3 frS Designer: Installer: e -cw EVL L e- Gfl—�e L Address: ra- Address: 3 cac 7 G`} >0-67 dZ�y�ti On 10- 2 r 2 9 �,q,�,�',� �.�ter ' was issued a permit to install a (date) (installer) septic system at 3? Gax,4 50X5-- IA-f v,- based on a design drawn by (address) �2-�' ►-� dated e /gl 3 (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral.relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. �Z0 OFA. 0 BTEPHEN �' �� C ler's Signature) C No.36461 (Designer's Signature) (Affix Desig is Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Revised.doc E co 'yq y GC1uE,© '°� I999 ' P ,W COMMONWEALTH OF MASSAC ??,� �RS EXECUTIVE OFFICE OF ENVIRONME - FA John Grad DEPARTMENT OF ENVIRONMENTAL PROTECTION DEP Title V Septic Inspector ONE WINTER STREET BOSTON MA 02108(617)292-3500 P.O.Box 2119 TeaTicket,Ma. (508)564-6813 TRUDY COXE Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS { Governor Commissioner SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION Property Address: 37 LONGBOAT DR. CENTERVILLE Name of Owner MR.VINCENT Address of Owner: SAME Date of Inspection: 6/12/99 Name of Inspector:(Please Print)JOHN GRACI I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: n/a Mailing Address: n/a Telephone Number: n/a CERTIFICATION STATEMENT 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 inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.The system: X Passes The inpection is based on criteria defined in Title V Conditionally Passes code 310 CMR 15.303.My findings are of how the system is _ Needs Further Ev I tion By the Local Approving Authority performing at the time of the Inspection.My Inspection does _ Fails not Imply any warranty or guarantee of the longgevity of the septic system and any of Its components useful life. Inspector's Signature: • Date:6/14/99 The System Inspector shal submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(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 Department of Environmental Protection.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. NOTES AND COMMENTS THE SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. revised 9/2/98 Page 1 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:6/12/99 INSPECTION SUMMARY: Check A, B, C, or D: A. SYSTEM PASSES: I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist.Any failure criteria not evaluated are indicated below. COMMENTS: System passes Title V inspection 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. Indicate yes,no,or not determined(Y,N,or ND).Describe basis of determination in all instances.If"not determined",explain why not. Wa The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal,is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent.The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. nta Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box.The system will pass inspection if(with approval of the Board of Health). _ broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced . nta The system required pumping more than four 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 revised 9/2/98 Page 2 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:5/12/99 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 the public health,safety and 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 ThE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of 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 AND SAFETY AND THE 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 soil absorption system and the SAS is within a Zone I of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well, The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform 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 ppm,Method used to determine distance nLa_(approximation not valid). 3) OTHER n/d revised 9/2198 Page 3 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:5/12/99 D. SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303.The basis for this determination is identified below.The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No X Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. X Liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow, X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped n/a. X Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. X Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone I of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well, X Any portion of a cesspool or privy is less-than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.If the well has been analyzed to be acceptable,attach copy of well water analysis for coliform bacteria,volatile organic ompounds, ammonia nitrogen and nitrate nitrogen. X The liquid level in the SAS is over the invert pipe,is in Hydraulic Failure. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X 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) The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.30412).Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:6/12/99 Check if the following have been done:You must indicate either"Yes"or"No"as to each of the following: Yes No X Pumping information was provided by the owner,occupant,or Board of Health. X None of the system components have been pumped for at least two weeks and-the system has been receiving normal flow rates during that period.Large volumes of water have not been introduced into the system recently or as part of this inspection. X As built plans have been obtained and examined.Note if they are not available with N/A, X The facility or dwelling was inspected for signs of sewage back-up. X The system does not receive non-sanitary or industrial waste flow. X The site was inspected for signs of breakout, X All system components,excluding the Soil Absorption System,have been located on the site. X The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for condition of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum.The size and location of the Soil Absorption System on the site has been determined based on: X Existing information,For example,Plan at B4O,H, X Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [1 5.302(3)(b)] X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. revised 9/2/98 Page 5 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:6112/99 FLOW CONDITIONS RESIDENTIAL: Design flow:-=g.p.d./bedroom Number of bedrooms(design): 2 Number of bedrooms(actual):2 Total DESIGN flow: 22Q Number of current residents:2 Garbage grinder(yes or no):NO Laundry(separate system)(yes or no): NO If yes,separate inspection required Laundry system inspected(yes or no):JLO Seasonal use(yes or no):M Water meter readings,if available(last two year's usage(gpd): nta Sump Pump(yes or no): NQ Last date of occupancy: Wit COMMERCIAL/INDUSTRIAL Type of establishment: Wa Design flow: n&gpd(Based on 15.203) Basis of design flow: nLa Grease trap present:(yes or no):M Industrial Waste Holding Tank present:(yes or no): NO Non-sanitary waste discharged to the Title 5 system:(yes or no):NQ Water meter readings.if available:WA Last date of occupancy: n& OTHER: (Describe) Wa Last date of occupancy: Wa GENERAL INFORMATION PUMPING RECORDS and source of information: nta System pumped as part of inspection:(yes or no):NQ If yes,volume pumped W& gallons Reason for pumping: Wa TYPE OF SYSTEM X 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) I/A Technology etc.Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other: nLa APPROXIMATE AGE of all components,date installed(if known)and source of information: 1981 Sewage odors detected when arriving at the site:(yes or no): NQ revised 9/2/98 Page 6 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:5/12199 BUILDING SEWER: (Locate on site plan) Depth below grade: 1C Material of construction:_ cast iron _40 PVC X other(explain) Distance from private water supply well or suction line: TOWN Diameter: Ella Comments: (condition of joints,venting,evidence of leakage,etc.) Ella SEPTIC TANK: X (locate on site plan) Depth below grade: tL" Material of construction:X concrete_ metal_ Fiberglass _ Polyethylene _ other(explain) Ella If tank is metal,list age Is age confirmed by Certificate of Compliance(Yes/No): MO Dimensions: L 8'6"H 5'7"W 4'10" Sludge depth: Z Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:1" Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: 1Z How dimensions were determined: MEASURED Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND RECOMMEND PUMPING SYSTEM EVERY TWO YEARS GREASE TRAP: (locate on site plan) Depth below grade: Material of construction:_concrete_ metal_ Fiberglass _ Polyethylene_other(explain) Illa Dimensions: Ella Scum thickness: Ella Distance from top of scum to top of outlet tee or baffle:-n& Distance from bottom of scum to bottom of outlet tee or baffle Ella Date of last pumping: n/a Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage, etc.) nla revised 9/2/98 Page 7 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:5/12/99 TIGHT OR HOLDING TANK: NO (Tank must be pumped prior to,or at time of,inspection) (locate on site plan) Depth below grade: a& Material of construction:_ concrete_ metal_ Fiberglass _Polyethylene_ other(explain) n& Dimensions: n& Capacity: nLa gallons Design Flow: n/a gallons/day Alarm present: NO Alarm level:jit& Alarm in working order:Yes_No_ NO Date of previous pumping: nta Comments: (condition of inlet tee,condition of alarm and float switches,etc.) . nla DISTRIBUTION BOX: X (locate on site plan) Depth of liquid level above outlet invert:1 IOUID LEVEL WITH BOTTOM OF PIPE Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) DISTRIBUTION BOX IS STRUCTURALLY SOUND PUMP CHAMBER: DLO (locate on site plan) Pumps in working order:(Yes or No): DLO Alarms in working order(Yes or No): NQ Comments: (note condition of pump chamber,condition of pumps and appurtenances.etc.) nLa revised 9/2/98 Page 8 of 11 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:6/12/99 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,if possible;excavation not required,location may be approximated by non-intrusive methods) If not located,explain: ilia Type: leaching pits,number: 1000 GALLON LEACH PIT leaching chambers,number: _nta leaching galleries,number: _WA leaching trenches,number,length: n& leaching fields,number,dimensions: n& overflow cesspool,number: n& Alternative system: n& Name of Technology: -Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation,etc.) THE LEACH PIT IS STRUCTURALL SOUND AND FUNTIONING PROPERLY PIT HAS NOT BEEN MORE THAN 112 FULL CESSPOOLS: _ (locate on site plan) Number and configuration: nLa Depth-top of liquid to inlet invert: n& Depth of solids layer: nla Depth of scum layer. nLa Dimensions of cesspool: Wa Materials of construction: WA Indication of groundwater: n& inflow(cesspool must be pumped as part of inspection)Wa Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) n& PRIVY: _ (locate on site plan) Materials of construction:n& Dimensions:Wa Depth of solids: n& Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) i>La revised 9/2/98 Page 9 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:6/12/99 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100'(Locate where public water supply comes into house) n/a cl � A636 �Q A y D W a5 0 31 revised 9/2/98 Page 10 of 11 w SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 37 LONGBOAT DR.CENTERVILLE Owner: MR.VINCENT Date of Inspection:5/12/99 NRCS Report name: nta Soil Type: Wa Typical depth to groundwater: nLa USGS Date website visited: n& Observation Wells checked: MQ Groundwater depth:Shallow _ Moderate _ Deep _ SITE EXAM _ Slope _ Surface water _ Check Cellar _ Shallow wells Estimated Depth to Groundwater 12 Feet Please indicate all the methods used to determine High Groundwater Elevation: _ Obtained from Design Plans on record X Observed Site(Abutting property,observation hole,basement sump etc.) Determined from local conditions _ Checked with local Board of health Checked FEMA Maps _ Checked pumping records _ Checked local excavators,installers X Used USGS Data Describe how you established the High Groundwater Elevation.(Must be completed) USGS MAPS AND CHARTS AND VISUAL revised 9/2/98 Page 11 of 11 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign m item 4 if Restricted Delivery is desired. .� ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. g. Received by(Printed Name)kaeq C. Date of Delivery ■ Attach this card to the back of the mailpiece, C or on the front if space permits. D. Is deliv nt from item 1? ❑Yes 1. Article Addressed to: / If Y ,en-r delive ss below: ❑ No c' �n 1% (tea r✓lis LA VIA aP � do 3. Seervic ,,a Certified Mail ❑Express Mail ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. . 4. Restricted Delivery?(Extra Fee) ❑Yes 2.,Article Number (7i r (Transfer from service/abet) ' j i f 7.0 8 =18 3 0'J 0 0 0 2 i 0 5'0 0 '8 6 D 4 PS Form 3811,-February 2004 Domestic Return Receipt 102595-02-M-1540 UNITED STAT � *QMQ.# Cal.2 1-..- f I `" .., 5 ivrr�p„ `a'� I ° Sender: Please print your name, address, and ZIP+4 in this box • I Town of Barnstable Health Division 200 Main Street Hyannis, MA.02601 I I III ctts flit t Ill Illit,3t11111.tE111111111 Ill fill 1it;1111��t1111'►1 i /93 -Ober N 8> ..°2.._.. .. z ' " FRs.............................. 930 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH TC/.4✓./N......................OF....�Qf1.r. J T! .�9.. . .._...._.._............._...._.....__. 17 Appliration for Diopooai Works Tonstr.urtion ramit Application is hereby made for'a Permit to Construct (, or Repair ( ) an Individual Sewage Disposal System at: Location-Address or Lot No. - 4- ...................: .......�' <rr-..(:c - -- _----------------------........................ Owner Address W .................................. ....................'-•----....... Installer Address UType of Building Size .......Sq. feet �., Dwelling—No. of Bedrooms....2.Z-s.Ci............................Expansion Attic (ilia Garbage Grinder (c d) pa., Other—Type of Building iftv-c_*............. No. of persons......:;I.!cP------ Showers ( /) — Cafeteria ( ) wOther fixtures --•--------••-----------------------------------•--•--..._.••---------------- W Design Flow...................... ...................... per person per day. Total daily flow..................,:....3.-4..0_.......gallons. WSeptic Tank—Liquid capacity.6AZo!ogallons Length................ Width................ Diameter..._......_..... Depth................ x Disposal Trench—No..................... Width.................... Total Length.....................Total leaching area....................sq. ft. Seepage Pit No............. ...... Diameter...........P_.'..._ Depth below inlet......G........... Total leaching area.Q?G.!_....3.sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by---C�410.1!e...�,d_._J?tn-irY..L'aNsr� .t2-? Date_____.7-O-_:_?•9- ------------ Test Pit No. 1.".....a...minutes per inch Depth of Test Pit.....t�.__'...._ Depth to ground water---oce..0............. 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ a -•------------•••-... .•---•..................•------•-•.........-----•......•--•--..............---........................................................ O Description of Soil Y..... 'x '' �` ,SI�,BsSF�- .......................................................................................... Y.:s----•---------"-s. .......5!2.!�ra..s-............................................................................... C::-ea----------------� .....__fist.e ''� `al. U Nature of Repairs or Alterations—Answer when applicable................................................................................................ ------------------------------•••-------•---•••--•---------------•------•--•--•--•--._..._••••-•---••-•-----••-•--•--•--------•----•--...•-------•-----••-••--•••-•-•-----......---•-------•••••'-'----- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL U 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Si ned =I --••---- -- ac '`'a----•...-----•--••-------�_ ; 6 --0 9............ D e Application Approved By.....- +- -._...... •-••-• -_.. _Z71„/------_----- Application Disapproved for the following reasons______________________________________ ----•------•----••--------------------•------•--•--..Date•----•-•••-•-• .........-•--__•--••'---...---•-•-•--•-....._...•-•--••......--'-----•-_-_••----'----•-•-•-•------____•--•----•--------------------------------•---•----._...---•----•-••----•--•••---•---•-------_..._ Date PermitNo....................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH , ppliration for Disposal Works Tonstrnrtion Prrutit Application is hereby made for a Permit to Construct ( ,.� or Repair ( ) an Individual Sewage Disposal System at: ...... ....Th•e'�' �QM ..__rG'� .�.r9 fiP...`----.._ ------ Locatio-nn-Address or Lot No. ez ;/0—i O ....... ............................................................. Owner Address ......... .�sr._� r r�o.- •------------- - r x�-rs----•--- z.a- ................------------------ Installer Address UType of Building Size Lot._. �.� _E.....Sq. feet �. Dwelling—No. of Bedrooms....TGc.j.G............................Expansion Attic (,V,' Garbage Grinder (, Other—T e of Building .......... No. of persons..........7`1_. .F?.• Showers Cafeteria a' Other fixtures .................................. W Design Flow.........................5--............ per person per day. Total daily flow.......................... .....gallons. WSeptic Tank—Liquid*capacity...toe_gallons Length-------_------- Width--------_....... Diameter................ Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area___.-_-----__-------sq. ft. Seepage Pit No...............i.... Diameter............ -- Depth below inlet..........:...... Total leaching area.,- ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by__ �.1�r�._.c?c� i_._s^r�,c-,tr_��;.fa G� . .?ems Date........ Test Pit No. 1...._..`.... .minutes per inch Depth of Test Pit.._._..,..A........ Depth to ground water.....<. .. ........... �X, Test Pit No. 2................minutes per inch Depth of Test Pit...................... Depth to ground water........................ 9 ••--••••--•••-••••••••••---•.....-•-•............:.........•-•---•----..._.................-----•............................................................ D Description of Soil....._.....©-.5?...........cCr-=?...' ._, Gc {-------------- U -•--•----•----•----•-•-------••---------..ii�.....-........ .......T d/!.C...... a,d-•-----------------•-•--•-------------------..............---............... UW ............................................................ m..._.15`e v. ...•----.....-•--------•-•-•-----•------•-------•---------------...----•-...... Nature of Repairs or Alterations—Answer when applicable.._.......... .................................................................................. ....•-••...... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT12 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed-- /ae.r�..'c- ,. . ............................... ---.6-' T `.1..... Application Approved B D Date Application' Disapproved for the following reasons:................................................................................................................. ........................................................................................................................... ------------------ Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT� d-1„ ...........oF........::. : .....::........................................................ Trrtif irtttr of ftontpliFana THIS IS TO CERTIFY, That the dividual Sewage Dispgssal System constructed ( ) or Repaired ( ) r uer ------------------- has been installed in accordance with the provisions of TIT r r of The State Sanitary Code as described in the application for Disposal Works Construction Permit No...... Wes_._L:._f f_._..__., dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE® AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..................................... ............... Inspector------.&A--�--------------•------------------•-----...............-•--•-. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ...........................................OF.... NO... .4.!- .11. FEE............................. Disposal Works 0oy�nar init rrntit Permission is h reby granted------•••-••.. ------------ .4.>H- = to Construct ( or Repair ( ) an Individual Sewage Disposal S stem Street as shown on the application for Disposal Works Construction P o.__j_..�.._........... . Date ........................................ a.. ealth DATE------------------•-- FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS ttn x 3 '3t� G i'C7 , �DCt�tDtt i �I LC/AL— AV- Y (50 tromp cep- ,< 7c-�, G.P.T-). ToT1at: -r->ESl6W = A-25 6-PI.D. qa.q a _ .�.4: Plt:-�fzct>L&TtoQ At"t� : tts 2hctu oiz LP-SS. t M 1474. _ �FX. 'x ('�`�f ; ate, ! 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I - I I I I i I � I I � .1 , I I , � I - I I I ,- I t � 11 I . . . I�� I � I I I I � I - -;, . I � , . I _� � I �I� I I . I I I : I I I , I I I I I I . I • . , I . I �. � ., � I I I I I � - . -I � � : I I� � ' I .- �l 'ACCESS COVERSMUST BE WITHIN I 1. I- - I I ., . I . - I� I . 1 I ; . l I 9- MINIMUM. ' .. � I INVERT EL E,VA T] ONS : � ' " DES I GN , -CR I TER ] A : , 11 � I � I 11 � . I : I I � I I � . . � I 1 I . . � . _. I I I I � I ' 'MAXIMUM COVER I ' � I ' FIRST 2'. TO I � I E I � I I I � I � I I INVERT OUT SEPTIC.TANK: -94.0 1 � � . DESIGN FLOW: - � ,�, I ,� I � I . I I I � 1. I 1 '1 � .1 - I�,411, MAX GRAD . I . , ' � . . � I I ' I - I , ' INVERT IN DIST. BOX: - � 92,77 13 'BEDROOMS'AT I/O G.-P.D. PER ' ' I 11 MIN 2* OF PEA STONE TONE � I I � I. THIS PLAN IS FOR, THE DESIGN AND CONSTRUCTION ,BE LEVEL ' . __ EL-93.0 � " . I I I I 11 I OR FILTER FABRIC 1 II,I iIi NL V,. E.- R T, 1.OU,T 1 I..�l D*I_,IIST- . BOX: OX: 9,�I,�,1I2. e �.�I P , .. D� . I:I OI-.,II, F T HE SEWAGE EWAGE I DISPOSAL -.".I,,��-� I:II_�,SP O II.S A� ft-.�L � I,I SYSTEM YSTEM 1' ONLY. I' : .I ..l: , - "I .- .I �. I I, r 1,1 'I ". � 1 '2 . � . M, , " l 1 . 1'*I,I� -- I I�i1�'II.�I ., . _I �I11�I�1_".1�1, - ,I- -1� I 1, .I1 II,�I,:lI , -I ; 1 - ItI I 1 I , 1 I 4' AM PL1, 314' - 1 112' DIA. INVERT IN LEACH CHAMBER: '89.0 � 1 94*0 92.6 6 DOUBLE WASHED BOT fOM OF LEACH CHAMBER: 87.0 NO GARBAGE GRINDER 2. VERTICAL DATUM IS ASSUMED. FOR BENCH MARKS . 2 % SET, SEESITEPLAN. ;r CAS ' ADJUSTED GROUND WATER: NIA BAFFLE 9;.77 89.0 "" I 2-500 GAL LEACHING CHAMBERS OBSERVED GROUND WATER: NIA SEPTIC TANK REQUIRED: ' 3. ALL'CONSTRUCTION METHODS AND MAT EXISTING 3 OUTLET 330 G.P.D. X 200x 660 GAL. ERIALS AND 1: - D-BOX W14' STONE AROUND. 12.8's x 25*1 x 2*d - BOTTOM OF TEST HOLE *l: 82.0 SEPTIC TANK PROVIDED EXISTING MAINTENANCE OF THE SEPTIC SYSTEM SHALL /000 GAL CONFORM TO MASS. D.E.P. TITLE 5 AND LOCAL SEPTIC TANK 6' CRUSHED STONE OR . SOIL ABSORPTION SYSTEM REOUIRED: BOARD OF HEALTH REGULATIONS. COMPACTED BASE- . SOILEXTURAL CLASS - I 4. ALL SEPTIC SYSTEM COMPONENTS LOCATED UNDERPROF I L E : NOT TO SCALE ` . EFFLUENT LOADING RATE - 0.74 6PDISF AREAS SUBJECT TO VEHICULAR :TRAFFIC OR GREATER / 0.74 GPDISF - 446 S.F. REQUIRED , THAN 3' IN DEPTH SHALL BE CAPABLE OF W1TH- STANDING H-20 WHEEL LOADS. , I LEACHING CHAMBERS . W14' STONE AROUND. A-471 S.F. L BE SCHEDULE 40 PVC. OR . 4 .APPROVED EOUAL. I . N � 6. SEPTIC SOIL TEST PIT DA TA's PRECAST CONCRETE OR APPROVED POLYETHYLENE. Ii BOTH SHALL BE WATERTIGHT. D-BOX SHALL, BE WATER INDICATES INDICATES 9 PERCOLATION = OBSERVED TESTED FOR LEVEL WHEN THERE IS MORE. THAN ONE 103 TEST = GROUNDWATER OUTLET.!, I I,I ------ TP #/ TP *20 �, 7. BEFORE CONSTRUCTION CALL *DIG-SAFE*. � AND THE LOCAL WATER DEPT.TEXTURE COLOR HORIZON TEXTURE COLOR .' O' 93.0 O' 94.0 FOR LOCATION OF UNDERGROUND UTILITIES. .c A LOAMY IOYR ,A' , LOAMY IOYR . 1 )0 56 SAND 212 - , SAND 212 1 % 5 . I ........ 8. SEPTIC SYSTEM INSTALLER SHALL NOTIFY THE - . ' - .! 1 go 00---� .,---. DESIGN ENGINEER TWO DAYS PRIOR TO CONSTRUCTION 1� " 0 . .", LOAMY IOYR LOAMY IOYR � ___10A - B Or THE SYSTEM TO ALLOW FOR SCHEDULING OF THE ,I SAND 518 SAND 518 . % 32*. ....................... - 90.3 30- 9 1.5 TR \ 4 CONS INSPECTION$. c / FINE-MEDIUM IOYR C / FINE-MEDIUM IOYR .1 % � \\ ,,lgl SAND 614 SAND 614 9. , EXISTING LEACH PIT TO BE PUMPED DRY AND \ , - - BACKFILLED. 102 \ eel ♦\\\ tp 10. ALL UNSUITABLE MATERIAL (A & 8 HORIZONS) I ♦ \N\\ p,.k\ \\\ 0 --+ i .. ENCOUNTERED BELOW THE- INVERT OF THE LEACHING % \" - FACILITY TO BE REMOVED FOR A DISTANCE OF 5. \\\ ";F \N v0sl1 M AROUND AND REPLACED WITH SAND IN ACCORDANCE \ \ ., W/TH TITLE 5. 1 \\\ %\ am k GARAGE --- - 132 NO WATER 82.0 132. NO W4 TER 63.0 II FLOOR.\EL-98.1 ` c I \ � A 2-500 GALLON k\ � E)W(No rps LEACHING CHAMBERS DATE: JULY .' \ " P-7.J -- �lT...... A. -T-- F14' STONE ROUND TEST BY: STEPHEN HAAS LOT I2A _l -"-- EXISTING :,, SEPTIC TANKI -:- 0 .: .:: �__ b 15. 820± S.F. '42 / 96/If 146 / ; . - . . I +97.0 , /1 -�4 I - /- i � - - I RTIAL SOIL REMOVAL t, 0 -- 1 1 O -- iE-NoTe-M : �� , � , .-, iS.6 r1 . , e an _7-, t 11 40 MILL POLY -- '71 3. _ ___-___ts. -__ VAPOR BARR IER 14, / m , ,� _8 _ _ 11 11 6 __- 86,4 _ ,, . t -f_#f , ', SEP T / `CIS YS TEM DES / 0/\ ---- . - ___---- - , ------_ I ._ ____. 07 rL 0NOBOA T DR / VE . MA P / 93 . PARCEL I 58 , .82 - I 1 . 3 � A.R NS rA8L � E,� "All, � e CE / 7ER V / I F )" �___ Iq0._ I ' . I -_ , I I , 0 PREPARED )=OR6I , , _ \ .Rourr 6 i SERVI -_-s 1 , I1 ' � 1 6 R .7 Z 0 � =/Vs / ,E_ K L EGEND IER = - 1 r 5 I � .A_ , , I OOM / S ' LNeCTVTTR V / L L E' . "A 012 L u ; a / - 58I L . . . . - 1. ,t / 0 �B CONCRETE BOUND l I I, W W OER LINE . , - I I � . 0 HYDRANT I S CAL T /" " " 2�0 AOCUS 7 / 9 "I oov I OCSLU � ! , : 9 I . - . I Y , , OAS LINE 1 � _ _ - � 1 , - - V AIWIRES 1� HW OERHEDO 1 0r ,'1, , 923 Route 6A 0 LIGHT POST, i� -4 � � � •-_� ': ; 7E= :� ,- 1 .� ,� rn&6t hpc t t MA . 0267 ;" 1 UNDERGROUNDELECTRIC L I NE 0 , - , , . 1 . 508 362" 8 32 I - ,' 1-. I11 - I , UNDERGROUND.TELEPHOkt L INE I I � � I - I I 5 0 8 4 32-5 333CTV , UNDERGROUkD"CABLEVISION LINE 1 ( 1 1 1�_ , x I li�, SPOT ELEVATION. - , ,.! -I 4 R ". , ,I-, I1 - I1 ,-I < I 0 O EXI$TING tONTOU 1 � � -� ,REVISED� OCT08ER / .', :2000 - I .- � ,, � _ � , , � � �PROPOS D,lC0NTOUR V 1 10 0 40 � � I �t � , I 'I- , - m ,"4 . -, FEFWIECAC $AHICFW CHECK.- VFW O N. SAPL 0CUS , MAP 1 1 JOB HO-.�.09 4057ILD CEK L t � l ..' I , 11 . 2 ,1 _ __ " , I _• , , 11 11 - � � , � I - _ , _ c -L ,. 1 � ,1 � ,� ,. , I . 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