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0137 MAIN STREET (CENT.) - Health
s 137 Main Street ' Centerville _A=298—094____ UPC 12534 , No.2��� an 1511505:19p -'' p•16k Commonwealth of Massachusetts •vim, ' Title 5 Official Inspection Form ,t ,3 61 41V Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Ir— iT> 177 Main Street Property Address Marcy Rozanel Owner Owners Name Qq r, information is required for every Centervillel NIA 02635 1-2-15 1-' page. City/Town State Zip Code Date of Inspection F P'Q Inspection results must be submitted on this form. Inspection forms may not be altered in any way.Please see completeness checklist at the and of the form. Important:When A. General Information fillingng out out forms ,��1��IIt11111� on the computer, y/�;(/�► p��`��H OF qS�iO� use only the tab 1. Inspector: Jl s9c�% key to move your I✓ o�;' yG's cursor-do not James D.Sears ? JAMES u,_ use the return key. Name of Inspector = c CapewideEnterprises,LLC =* {�.0� O •� � Company Name 3�',T,t•TfF�'=�� 153 Commercial Street '� ,$ IN511 Company Address +� Mashpee MA 02649 Cltyrrown state Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification a on I certify that I have personally inspected the sewage disposal system at this address and that the information deported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-2-15 -�16speclor's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. "'This report only describes conditions at the time of insp ection 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. L10 I Z � 15im-31 3 TWe s DRaal n Form:Subsurface Sewage D I System•Page 10117 Jan 15 15 05:19p p,2 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centervillel MA 02635 1-2-15 page. Cityrrown Stale Zip Code Date of Inspection B. Certification (cunt.) Inspection Summary. Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist Any failure criteria not evaluated are indicated below. Comments: The system is a 1000 Gal.Tank D Box and 20 Biodifussors Chambers. Conn.Pass need to replace main line. Need to seal tank. S) 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,"{Tease explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15i ns-W 3 Title 5 Official he pedion Fomt Subaurlace Savrage Dt9posal System-Page 2 of 17 Jan 15 15 05:19p p.3 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centervillel MA 02635 1-2-15 page. City/Town state Zip Code Date of Inspection B. Certification (cunt.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumpsialarms are repaired. B) System Conditionally Passes(cont.): ® Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ® broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): Need to replace main line. Need to seal tank. ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s):The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Tide 5 Otfidal Inspa%on Farm:Subsudew Sewage Disposal System-Page 3 of 17 1 Jan 1515 05:20p p.4 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal.System Form -Not for Voluntary Assessments .177 Main Street Property Address Marcy Rozanel Owner Owner's Name informrequired s Centervillel MA 02635 1-2-15 required for every page. Gtyrrmn State Zip Code Date of Inspection B. Certification (cunt.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well`*. Method used to determine distance: "*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal c:oiiform 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 1/2 day flow L5ins-3113 TNe 6 OffidW Nspecdon Form:Subsrafece S&*"a Disposal Syalem-Pape 4 of 17 Jan 1515 05:20p p.5 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Narne Information is required for every Centerville[ MA 02635 1-2-15 page. Cttyrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 9 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system faits. 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 ❑ 0 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 i Ely s 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. t5ies•3/13 . title 5 Olficw InspeWon Form:Substeace sewage Oisposs!system•Page 5417 Jan 15 15 05:20p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centervillel MA 02635 1-2-15 page. Cityftown 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 ❑ E 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? El ED 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 NIA) ❑ 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)1310 CMR 15.302(5)) 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 t5ins•W 3 This 5 Official Inspection Foam:Subsuftw Sewape Disposal System•Page 6 of 17 Jan 15 15 05:21 p p.7 Commonwealth of Massachusetts Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name required fo is Centervillel MA 02636 1-2-15 required for every page. Cityrrown State Zip Code Date of inspection D. System Information Description: The system is a joeoGal. Tank D Box and 20 Biodifussors. Number of current residents: 0 Does residence have a garbage grinder? Q Yes No Is laundry on a separate sewage system?(include laundry system inspection (� Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2012-25,000Gais g ( y g (9p ))' 2013-19,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA Date Commerciailindustrial 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. N available: t5ins•3013 Title 5 Mdal Inspecdon Form:Subsurface Sewage Disposal Syswm.Page 7 of 17 Jan 1515 05:21 p p.8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments T 177 Main Street Property Address Marcy Rozanel _ Owner Owner's Name. information is required for every Centervillel MA 02635 1-2-15 page. City/Town Stale Zip Code Date of Inspection D. System Information (cont) Last date of occupancyluse: Date Other(describe below): General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Altemative 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 UA system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): rsino•3M3 Title 5 Official Inspection Form:Subsurface Sawaoe Disposal System•Pace 8 of 17 Jan 1515 05:21 p p.9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centervillel MA 02535 1-2-15 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont) Approximate age of all components,date installed (if known)and source of information: Tank NA New D Box and leaching 2010 Permit 2010- 194. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 22 11 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting,evidence of leakage, etc.): Pipeing is 4"PVC SCH-40. Need to replace main line, last 6' under water. Septic Tank(locate on site plan): Depth below grade: 11" feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age. years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes o Dimensions: 1000Gal. Precast H-10_ Q„ Sludge depth: t5lns•3113 Tipe 5 Olridal Mspectim Font:Subeiafam Sewage Dtapoeal System•Page 9 of 17 Jan 15 15 05:22p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centervillel MA 02635 1-2-15 page. Cityfrown state Zip Code Date of Inspection D. System Information (cunt.) Septic Tank(cunt) Distance from top of sludge to bottom of outlet tee or baffle 30" Q. Scum thickness Distance from top of scum to top of outlet tee or baffle 26" Distance from bottom of scum to bottom of outlet tee or baffle At Tee Bottom How were dimensions determined? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank water level at seam-Leaking.Tank and cover at 11 below grade. In and out let tee's. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3013 Title 5 ORoiel Inspedion Fort Subsurface Sewage Disposal System-Page 10 of 17 Jan 1515 05:22p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Form " Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information is required for every Centerville] MA 02635 1-2-15 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 W outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be.pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No tslns-3M3 Tile 5 orfidai Inspection Fornm Subaurtace sewage oWPDS l Sysum•Pape 11 of 17 Jan 151505:22p p,12 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owners Name information is required for every Centervillel MA 02635 1-2-15 page. Ctty/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 20"x2T-45" below grade wlcover at 20 Box is clean and solid w/five Vine's out. Note: In let line has a tee on it Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No' Alarms in working order. ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): i If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t51ns•3113 - Titla 5 Official hupection Forth:Subudece Sewage Disposal System.Page 12 or 17 Jan 15 15 05:23p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street Property Address Marcy_Rozanel Owner . Owner's Name information is required for every Centervillel MA 02635 1-2-15 page, City town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: leaching chambers number: 20 ❑ leaching galleries number. ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovativefaltemative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is 20-1-12O Biodifussors ck D Box and camera out to chambers clean and dry. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3113 Trtle 5 016cie1 Unpeaon Form:Subsurface Sewage Dismsel System•Page 13 of 17 Jan 1515 05:23p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 177 Main Street C Property Address Marcy Rozanel Owner Owner's Name information required for every Centtervillel MA 02635 1-2-15 page. Ckyrrown State Zip Code Date of Inspecdon D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on sibs plan): Materials of construction.- Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): I t"na-3113 Title 5 Official#ispecoon Farm:Sigxtt- ece Sewage Disposal System•Page 14 of 17 Jan 1515 05:23p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owners Name information' required inevery Centervillel MA 02635 9 2-15 page. CofTown State Zip Code Date of Inspection D. System Information (coat.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below: hand-sketch in the area below Q drawing attached separately �} ►?f t71�' 8 l�✓ -� `13V ti 1 x 13_y: 9�' Jr 45 4 t5ine•3n3 Ti11a 501fida1 Fom>:Subawreae Serape©isposal System•Page 15 of 17 Jan 15 15 05:24p p.16 • . Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information Is required for every Centerville) MA 02635 1-2-15 page. City/Town State Zip Code Date of Impection D. System Information (cons.) Site Exam: ❑ Check Slope D Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 11'+ 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: 2010 Date ❑ Observed site(abutting propertylobservation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H_on file at BOH 11'+ no G.W.: Bottom of chambers at 5' below grade. Bottom of chambers at Vabove T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•U13 Title 5 OIfdA Inspection Form:Subsurface Sewage Disposal System•page 16 or 17 Jan 15 15 05:24p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 177 Main Street Property Address Marcy Rozanel Owner Owner's Name information required for every Centervillet MA 02635 1-2-15 page. Citylrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•W3 Title 5 ottdal In speWon Fonrc Subsuttaae Sewage t)isposel System•Page 17 of 17 Bk 22554 ps 1o9 �72232 1.2--19--20 07 & 11 ' 53a NOTICE: The Town of Bamstable Iecommendc that the-nn�n1 seek legal advice to prepare a Property worded deed restriction document. DEED RESTRICTION WHEREAS, P� - ,� �5 �� bS �� s name) of T. k,71 MA address) is the owner of ( ] i4,. (address) located at ih Ptzg�j `k p MA(hereinafter referred to as and being shown on a plan entitled "Subdivision of Land in MA, Property of et al, duly recorded in Barnstable County Registry of Deeds in Plan Book ( � `- S , page S Or on Land Court Plan Number WHEREAS, _Rv .2 -}���; �V s as the owner (owner's name) Of Said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number.of bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; .WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to grantip 'a disposal works construction permit for a septic system in compliance watt GMR 15.200, State Environmental Cod e, Title V, Minimum ReciUirer eats for the Subsurface Disposal of Sanitary Sewage, and authorizing the.issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, dear . I NOW, THEREFORE, Ci7 i ✓7"I w does hereby place the (owner's name) following restriction on his above-referenced land in accordance with his agraement_.muth_theTown.of_Barnstable-Bar-d-o�k{ea[th,-w hieh-restfietion-sha-It run with the land and be binding upon all.successors in title: 1. �� r'Y�,/�� ► ?iz:4 may have constructed (address) upon the lot a house containing no more than ►Je (i) bedrooms. agrees that this shall be permanent deed (owner's name) restriction affecting located on MA, and being shown on the plan recorded in Plan Book , Paged Or on Land Court Plan For title of see the following deed: Book %A-7 _ , Page ' ' Or Land Court Certificate of Title Number Execut a sea iyru) ent day ofc � �� 7 ner s signature Owner's signature Owner's signature COMMONWEALTH OF MASSACHUSETTS �- e , ss c� (� , 206 Then p rsonally qppeared the above-named .41 V2 4 'a":l known to me to be the person who executed the foregoing instrument and acknowledged the same to tLN e act and deed, before me, L Notary Publi�j My co mission expires: (date) deedr 7j� Certified Mail#7006 0810 0000 3525 2742 Town of Barnstable � � � Regulatory Services �s« NA RN.' OLL IMASS. Thomas F. Geiler, Director r�o 10� Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 April 24, 2007 Robert Davalos 137 Main Street Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION, THE STATE ENVIRONMENTAL CODE, TITLE 5. The property owned by you located at 137 Main Street, Centerville, MA was inspected on April 13, 2007 by Timothy O'Connell, Health Inspector for the Town Of Barnstable. This inspection was conducted on the basis of a complaint filed at the Town of Barnstable Health Department. The following violations of the State Sanitary Code were observed and Town of Barnstable Comprehensive Occupancy Ordinance: 105 CMR 410.300 and 310 CMR 15.00: There were a total of nine (9) bedrooms observed in this dwelling. However, the existing septic system (permit # 2006-365) was not designed for nine (9) bedrooms. It was designed for five (5)bedrooms. You are ordered to correct the violations listed above within sixty (60) days of your receipt of this notice by pulling any required building permits (if applicable); You are ordered to remove two of the bedrooms from the basement by removing entrance doors and by opening all door-way entrances to each room in the basement to minimum of five feet wide openings. This will bring the total bedroom count down from (6) six to the appropriate (4) four as designated by your septic permit. You must either complete the above alterations to the bedrooms or up grade the current septic system to represent the current number of bedrooms. Due to the fact you are not within the Zone of Contribution to public water supply wells you are eligible for this second option. This will entitle you to be able to keep the current number of bedrooms. This must be done with proper permits and engineered plans and be completed within two (2) years of your receipt of this letter. Q:\Order letters\Housing violations\Rental ordinance\14 franbil hyannis i I y You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, Health Inspector Q:\Order letters\Housing violations\Rental ordinance\14 franbil hyannis � ble P# Town of Barnsta Department of.Regulatory Services f JA • ' Public Health Division Hate eg` 200 Main Street.Hyannis MA 02601 i Date Scheduled Time Fee Pd. i Foil Suitability Assessment for S wQge Dim l J Performed By: Witnessed By:. LOCATION&GENERAL INFORMATION Location Address Owner's Name flS3 A'`O MAIN STIkccvM q�� 5�; e n�. I Address I� tcC [, Engineer's Name Assessor's Map/P4rce1: oZ to NEW CONSTRUCTION REPAIR i Telephone# rJiJa'�q� Via\ Slopes(%) �a Surface Stones A IA— Land Use Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft t P"ft Property Line �_ft Other ft Drainage Way . tions of test holes&perc tests, SKETCH:($freer name,dimensions of lot,exact loca locate wetlands in proximity to holes) 1^.J C. 1 ,_J7) [_J t t:_rl j Fes, 7a4,�S I Depth to Bedrock Parent material(gedlogic) I � � Weeping from Pit Face Depth to Groundwater. Standing Water in Hole: Estimated Seasonal iHigh Groundwater DtTF� TION FOR SEASONAL HIGH WATI+;I�TABLE Method Used: tee —''�-- Depth to$011 ritattl4s; In, Dep fr Depth Cib�erved standing. obs.hole: in, groundwater Adjustment Depth toiweeping from side of obs.hole: p�,{aCtbr,., - Adj'O undwflter vet,.,., Index Well# Reading Date Index Well level - PERCOLATION TEST Date �e 0 ore I ` 46 I ` Observation Timeflt9" ...�..---- -^---�"'—' Hole# Time at G' Depth of Perc -� (p M kr, r (0 t�"� -- I Time(91'.6") _ ._..._. Start Pre-soak Time.@ End Pre-soak Rate MnAnch Site Suitability Assessment: Site Passed Site Failed; Additional Testing Needed(YIN) Hole Data To Be Completed on Back orig inal: Public Health Division Observation **If percola#ou test is to be conducted within 100' of wetland,'you must first notify the on Div Barnstable C4>jtservattision>at least one(1)wedk prior to beginning. i DEEP OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture Soil Color Soil ! Other Surface(in.) (USDA) (Munsell) Mottling (Strucre,Stones,Boulders. Conslsten ravol) 3 7 rsyLo DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. C nsisten %Gravel) loYa3 ��4 o DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) {USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencX.%Gravel) :DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture 'Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structuree,Stones,Boulders. Consisten rn I Flood Insurant Rate Map: Above 500 year flood boundary No Yes Within 100 year boundary No Yes Within 100 year flood boundary No Yes Depth of Natutally Occurring Pervious Material Does at least fo r feet of naturally occurring pervious material exist in all areas observed throughout the area proposed Or the soil absorption system? - If not,what is the depth of naturally occurring pervious material? Certification I certify that on. I 1 61 (date)I have passed the soil evaluator examination approved by the Department of l nvironmental ec 'on and that the above analysis was performed by Me consistent with . the required trainin ,ex s n x rience described in 310 CMR 15.017. Signature ' Date Q:1SBt'7ICIPERCt.0RM.DOC �R U Y 1,57 17' ---------- ------------ C-6 U ell- jP(T e 14 5,5fc)v /o 0 i TOWN OF BARNSTABLE LOCATION 1 -3-7 Madw 5,rcier- SEWAGE VILLAGE e—"7g—A1T;5— J1 SSESSOR' M P&PARCEL �- INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY i�®Ojq pYv LEACHING FACILITY:(type) �(},�� (size) � ,� NO.OF BEDROOMS OWNER V O S PERMIT DATE: 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 = 7w D � r ( 3, No. G ... 3 6 5 Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Y ZRppl cation for �Digo!gal �&pgtem Con.5truction permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) [ Complete System ❑Individual Components Location Address or Lot No. d-j� a I n_ ee Owner' a�,Addr s,and Ted No. (fir rn/11 i—f lfGt,fO Assessor's Map/Parcel 2c) 0 _ L4 q Installer's Name,Address,and Tel.No. & �7r�t Desi ner's Name,Address and Tel.No. 53� / &P ��"`� "-� QD �a C•-�.! Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures J� l r Design Flow(min.required) - gpd Design flow provided 5 51P • �1`� 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 Ti e 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this 4oard of Health. Signed Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. _365— Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: \ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, R&ASSACHUSETTS Ye 2-op i`ation for "igPogal *pgtern Congtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( Abandon( ) stem[Nkom lete Sy stem y El Individual Components Location Address or Lot No. 17j lio 1 e4, Owner',sName,Acidreszs,and Tel Noc Ci YV) 1?4 Assessor's Map/Parcel 2Q 0 _09 14 Installer's Name,Address,and Tel.No. ' � Desi ner's Name,Address and Tel.No. ✓�/ /�(!/!� Po' )5* 1561, alv Is,/—M62W I G�`�'S� Pv �3G I-PAI C•fQJ.WAu A Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures i, Design Flow(min.required) gpd Design flow provided 5� - y� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ) Type of S.A.S. _. Description of Soil r Nature of Repairs or Alterations(Answer when applicable) A ` / f 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 I oard of Health. / Signed Date ) I Application Approved by Date Application Disapproved by: Date for the following reasons i w Permit No. Date Issued _. ._. r +r THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,tt t the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded V) ul Abandoned( )by ( , at / /V11 L,has been constructed in accordance l with the provi(/��ions of Title 5/and / e for Dis osal System Construction Permit No. b 3& ,5- dated Installer 1) 1C/( Designer ,L #bedrooms `j Approved design ow 0 gpd The issuance of this permit#11not be construed as a guarantee that the system will function�as desi ned. Date 1[J Inspector No. c� � �`� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS �Bigonl *pgtem,Congtruction permit Permission is hereby granted to Construct ( )) Repair CI.,) Up rade ( Abandon System located at ��/ / / � t 7'/'t"� 2 nZ?,� V i and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the dld"te o' of is permit: Date n � � Approved3by "" Town of Barnstable Regulatory Services ~O Thomas F. Geiler, Director w BNEWSTABLE. 6`9 Public Health Division ArE0N10�A Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Shav Environmental Services Inc Installer: ¢ Address: P.O. Box 627 Address: Sk- East Falmouth, MA 02536 ! L 4 On w� O 'nc was issued a permit to install a (date (installer) septic system at ( 37-� (� based on a design drawn by (address qq Shav Environmental Services Inc. dated (designer) Y 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 systern) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. ZN OF M,qS o� CARMEN (Ins ller's 'gna u o E. SHAY co No. 1181 0 'PFG�sTER� SAA11FN (Designer's Signature) (Affix Desi p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form TOWN OF ARNSTABLE rLOCATION -7 SEWAGE# VILLAGE _ A SESSOR'S MA`, &PARCEL INSTALLERS NAME&PHONE NO. �0 SEPTIC TANK CAPACITY 1-7 / ?t LEACHING FACILITY:(type) V (size) NO.OF BEDROOMS--, OWNER PERMIT DATE: ] COMPLIANCE DATE: NY Separation Distance Betwee ►t ' Maximum Adjusted Groundwa er 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 #: �. � � - z P ` r' j� ��, �•`� 6� Town of Barnstable ZVE do Regulatory Services snxxsrnsi Thomas F. Geiler,Director 9�50 MASS. ••� Public Health Division rEC N1pt A Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 3, 2006 Robert Davalos 137 Main Street Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 137 Main Street, Centerville,MA,was last inspected on May 24th, 2006 by, Raymound F. Dumas, certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Cesspools are full to the top. You have 60 days from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. BARNSTABLE HE TH DEPARTMENT c ean, R.S.; C.H.O. Agent of the Board of Health q09/0qy COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION M TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 3 7 7C-�" Owner's Name: Owner's Address: s m-e, Date of Inspection: P(o Name of Inspector: (please print) ysa�Osd�.��v�lgS Company Name: Df/rl•>ig sCavr�- Mailing Address: s-r,�y 04;7 Sri .�✓ Telephone Number: ,5 a K —77 8 C. 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 the inspection.The inspection was performed based-on my t training and experience in the proper function and maintenance of on site sewage disposal systems.I arir a"DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: `1 Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority w° ails Inspector's Signature: Date: 5-;2 Y—off 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. Notes and Comments '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. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 7 fr a Owner. Date of Inspection: 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 CUR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 exfrltration 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 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: Title 5 Inspection Form 6/15/2000 2 Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ! 4 i Nit Owner• Date of Inspection: cq V/d 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. 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Title 5 Inspection Form 6/15/2000 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 37 �tr�s+�('.� Owner: Date of Inspection: Szael4o D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No i/Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool a 'Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or dogged 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''/z day flow ✓Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped ✓Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ��Any portion of a cesspool or privy is within a Zone 1 of a public well. fAny portion of a cesspool or privy is within 50 feet of a private water supply well. _ AAny 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 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,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)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. You must indicate either`yes"or"no"to each of the following: (The following criteria apply to largekin ddition to the �a above) yes no _ the system is within 400 feete g water supply the system is within 200 feetry to a surface drinking water supply _ the system is located in a niive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water )Ply If you have answered"yes"to y quetion E the system is considered a significant threat,or answered "yes"in Section D above th arge system has failed.The owner or operator of any large system considered a significant threat under S 'on E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner uld.contact the appropriate regional office of the Department. Title 5 Inspection Form 6/15/2000 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: lco.c Owner: Date of Inspection: 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 th owner, cupant,or Board of Health 1/ 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? i, a�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? r/— Was the site inspected for signs of break out? 1� 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 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: Yes no �xisting 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 CUR 15.302(3Xb)] Title 5 Inspection Form 6/15/2000 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner. Date of Inspection: Z FILOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_ cam- Number of bedrooms(actual): DESIGN flow based on 310 CUR 15.203(for example: 110 gpd x#o bedrooms): Number of current residents: - Does residence have a garbage grinder(yes or no): Is laundry on a separate sewage system(yes or no): 10 [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): O �pd S� /�flao0 Water meter readings,if available(last 2 years usage(gpd)): 2-v0 Sump pump(yes or no):�O Last date of occupancy: [/�iE��fdl(� COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 C 15.2 Qpd Basis of design flow(seats/C on gft,etc.): Grease trap present(yes or no): Industrial waste holding re t(yes or no):_ Non-sanitary waste disc ged to a Title 5 system(yes or no): Water meter readings, ' available: Last date of occupancy se: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: A` '0T , �Q,//S/ fC e``"�' �' �' `/• Was system pumped as part of the inspection(yes or no): O If yes,volume pumped:_gallons—How was quantity determined? Reason for pumping: TYPE OF SYSTEM Septic tank, 'bution box,soil absorption system _Single ceKttac _Overflo Priory _Shared s )(if yes,attach previous inspection records,if any) _Innovatihnology.Attach a copy of the current operation and maintenance contract(to be obtained froTighttan copy of the DEP approval Other(d Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): Title 5 Inspection Form 6/15/2000 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM(INFORMATION(continued) Property Address: 7 ///4U,*1 16 Owner: Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: : cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction:_concrete metal_fiberglass_polyethylene _other(explain) If tank is metal list age: Is confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of udge o bottom of outlet tee or baffle: Scum thickness: Distance from to of scum to top of outlet tee or baffle: Distance from ttom 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,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of constriction: crete metal_fiberglass polyethylene_other (explain): Dimensions: Scum thickness: Distance from top scum top of outlet tee or baffle: Distance from om of scum to bottom of outlet tee or baffle: Date of last p ping: Comments(o pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Title 5 Inspection Form 6/15/2000 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM(INFORMATION(continued) Property Address: /3 7 /Nlu�r�GGT Owner. Date of Inspection: — b TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete -metal fiberglass_polyethylene other(explain): Dimensions: Capacity: allons Design Flow: allons/day Alarm present(yes or no): Alarm level: in orking order(yes or no): Date of last pumping: Comments(condition f alarm and oat switches,etc.): DISTRIBUTION BOX. reland esent must be opened)(locate on site plan) Depth of liquid level abovvert: Comments(note if box' 1istribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of ox, PUMP CHAMBER: (locate on site plan) Pumps in working orderY� — i Alarms in working order Comments(note conditiamber,condition of pumps and appurtenances,etc.): Title 5 Inspection Form 6/15/2000 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: '3? Owner: Date of Inspection: V' z SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching c bers,numb leaching gall 'es,n r: leaching trench umber,length: leaching field ,n ber,dimensions: overflow c spool,n ber: innovati /alternative system Type/name of technology: Comments( to condition:system. signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspeectioonnXlocate on site plan) Number and configuration: 2 �a�.,7a o-t° 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 or no):_ Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: (locate on ite plan) Materials of c tion: Dimensions: Depth of ds: Comm (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title 5 Inspection Form 6/15/2000 9 Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 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. r 3j to � Title 5 Inspection Form 6/15/2000 10 Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) v'Checked with local Board of Health-explain: r U SG.5 C hA r-t'5 4'00( W r I/ £Nip Checked with local excavators,installers-(attach documentation) [Accessed USGS database-explain: You must describe how you established the high ground water elevation: 7-►J 2 17 - V Title 5 Inspection Form 6/15/2000 11 Citizen Web Request Page 1 of 4 r JEl : uy hlfe '# e + .r" Logged In As: Citizen Request Management Monday,Jur TQwN\oconnelt Route to Users Search Requests Create Requests Request Information Request ID: 20846 Created: 4/11/2007 4:26:36 PM Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: Yes Request Category: Chapter II : Housing Substandard Estimated 4/13/2007 Change Estimated Mar April 2007 May Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 1 2 3 4 5 Created By: Fontaine, Tina Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Request DETAILS: LOCATION: 137 MAIN STREET(CENT.) 'Centerville, Ma 02632 Request Parcel Number Map: 208 ..° Block: 094 Lot: 000 The owner of this rental unit --- controls the temperature himself. Tenant states that when the owner Parcel Lookup thinks he is spending to much money he turns the heat off. Toilets don't work they have to pour a bucket of water just to get things down. No fire escape on the 2nd floor. 11 people http://issgl2/intemalwrs/WRequest.aspx?ID=20846 6/25/2007 citizen Web Request Page 2 of 4 total living there. Tenants pay in cash owner doesn't want checks. Owner tells them not to stay during the day, tenants have to leave during the day. Everyone shares one kitchen no vents above stove. No smoke detectors in house. Email: Track Request Progress Request Work History: Internal Note History: Entered on 4/17/2007 8:24:19 AM Entered on 4/11/2007 4:26:03 PM by O'Connell,Timothy by Fontaine, Tina TO and MM went to said location on 4-13- Linda from building wants to do a bust on 07. Knocked on door had no answer. Will this house please talk to her first before going follow up on later date. Will try to get with LE out. from building and both go out there. System entry on 4/11/2007 4:26:03 PM: Entered on 4/17/2007 3:48:49 PM by O'Connell,Timothy Assigned to O'Connell,Timothy On 4-17-07 went to said property. On System entry on 4/11/2007 4:26:23 PM: arrival witnessed four cars parked at property. I was met by one of the tenants(man) at the Related Request 20847 door and then another(women) once inside. They agreed to show me around house. During System entry on 6/22/2007 3:28:08 PM: my inspection I witnessed 6 bedrooms, 3 on second floor, and 3 on first floor. The also told Request Closed by oconnelt me there is a women who lives in basement which I did not have access to. I was also informed that there was 2 people in a cottage which could be illegal according to zoning. A total of 8 to 10 people are occupying this property. Permit# 2006-365 is for 5 bedrooms and plans show cottage hooked into said system. So with total count being (8): (1) bedroom in cottage, (1) in basement, (3) witnessed 2nd floor(2) witnessed on 1st floor and a 3rd which is believed to be a family room converted into a bedroom. Entered on 5/23/2007 3:44:47 PM by O'Connell, Timothy Order letter sent out on 4-21-07 Entered on 6/22/2007 3:28:08 PM by O'Connell,Timothy http://issgl2/intemalwrs/WRequest.aspx?ID=20846 6/25/2007 Citizen Web Request Page 3 of 4 This is in court with zoning. Will close Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) 3 di; Spe,{I Check_ 'Spell Check, Add document or image link: * You can also type in a folder name to see everything in the folder Current Links: I.AHealthVTim O'Connell\137 MaJn_st(cent)\ lee Time worked on request: 2.50 i Response time: 12700' *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. c) Reopen r Reopen and notify citizen Reopen.w Public Use: Printer Friendly Version Internal Use: Printer_Friendly Version http://issgl2/intemalwrs/WRequest.aspx?ID=20846 6/25/2007 Message Page 1 of 2 O'Connell, Timothy From: Palkoski, Christine Sent: Monday, June 25, 2007 10:57 AM To: O'Connell, Timothy Cc: McKean, Thomas; Weil, Ruth; Smith, Robert Subject: RE: 137 Main Street, Centerville Tim - Look at Request Id: 20846 - I think you just have to resolve the discrepancy between the 5th sentence and 10th sentence. In the 5th, you write 3 bedrooms on the first floor and 3 bedrooms on the second, and in the 10th, you write three on the second floor and two on the first floor. I guess that discrepancy was the basis of my confusion. I like that you write "witnessed" in the 10th sentence. -----Original Message----- From: Palkoski, Christine Sent: Monday, June 25, 2007 10:50 AM To: O'Connell, Timothy Cc: McKean, Thomas; Weil, Ruth; Smith, Robert Subject: RE: 137 Main Street, Centerville Tim: I have been looking at this address over the past few weeks and shortly plan on moving forward on enforcement action. At this time, I would ask you to re-do your report to reflect what you actually saw when you inspected this residence. As I mentioned earlier, your report may not be accurate, please fix it based on what you wrote below. If there were doors that you couldn't get into just state how many there were and that you could gain access to them because they were locked (or whatever the reason was). It is important that you state what you saw and your report isn't based on what you assume is there. Christine -----Original Message----- From: O'Connell,Timothy Sent: Monday, June 04, 2007 12:14 PM To: Palkoski, Christine Cc: McKean,Thomas; Giangregorio, Robin Subject: RE: 137 Main Street, Centerville Christine When I was at said property I recalled seeing (6) bedrooms but I did not have access to whole house as zoning and fire did. We were there on different day's. Although I believe there is at least (8) including the cottage and basement but may be more. Also within complaint# 20846 states Permit# 2006-365 is permitted for 5 bedrooms. To be considered a bedroom by the health dept. the room must be at least 70 square ft, have a window, a door and a ceiling height of 7ft . -----Original Message----- From: McKean,Thomas Sent: Monday, June 04, 2007 11:27 AM. 6/25/2007 Message Page 2 of 2 To: O'Connell, Timothy Subject: FW: 137 Main Street, Centerville Tim Please respond to the questions below: -----Original Message----- From: Palkoski, Christine Sent: Monday, June 04, 2007 11:14 AM To: McKean, Thomas Cc: Weil, Ruth Subject: 137 Main Street, Centerville Tom, I have reviewed both zoning and the fire department reports regarding 137 Main Street in Centerville. I have also located Tim's report in the database (id: 20846). Both zoning and the fire dept. state that in the main house there are two bedrooms on the first floor and four bedrooms on the second. Tim's report indicates that there are three on the first floor and three on the second. If he can recall, I'd like for him to clarify how the counted these bedrooms- maybe health counts/or doesn't count a specific room as a bedroom because of specific characteristics? If that is the case with this house, please let me know. I'd like to have all this information prior to being in court. Also, can you have Tim forward me the most recent septic information and what the capacity of the septic system is. Thanks. Christine 6/25/2007 AsBuilt Page 1 of 1 TOWN OF BARNSTABLE j LOCATION 3 �A 1 w 1 2�� SEWAGI _ VILLAGE �RAJr6KVQ_ASSESSOR M ;&!�PARCEL i ' INSTALLERS NAME&PHONE NO. .C - SEPTIC TANK CAPACITY LEACHING FACILITY:.(type) 3� D�C (size) NO:OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: ' Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility _ Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) _ FURNISHED BY vi ytj 0 tr O http://issgl/lntranet/propdata/prebuilt.aspx?mappar=208094&seq=1 4/17/2007 syvttcMrtliaat'4!" i ,v' 's; *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. TYPICAL 1500 GALLON SEPTIC TANK , VENT PIPE (0 Least 24 inches tall) SECTION A -A ; - 44�0 NOT TO SCALE ,3 �..�;' 10' min. from schedule PVC w/charcoal odor Filter PROFILE VIEW OF LEACHING SYSTEM Existing Foundation house to septic tank Septic tank coven must be within 6 in. of finished rode D-BOX oc, r must be TOF - ELEV 100.00 g w/in 0" of finished grade Not to Scale 3-2+• DIAM. ACCESS MANHOLES Grade over SAS- ELEV 9 ode over SAS - ELEV- e200 r Grade over Septic Tank- e200 d' of 1/1.- 1/d• Irerhed leerMne 10' -e' �• b 1 /// 1eeAed C/HMed dYav _ A TOTAL OF 2 :'+ -.v.at' ":�.+-.t:1s:' ; ' .1 P ,7 (vl'�i ?Bt s a S 4' PVC(CAPPED)IN PORT TO BE ,' �„ 0.02 3 HOLE H-10 INSTALLED AND TO BE 1MTHIN e'OF GRADE DIST. BOX 3' Mazimu Cover Top of SAS-EIev.=86.25 INLET a s 60' NEW S=D.O1 or Greater S- 0.010' per foot M' � btBtLTletllfl Ln FYLST. PIPE a 1,500 GAL. g s. r , Effective � FROM EXIST, FOUNDATION m SEPTIC TANK c6 S Oepth *! INLET `/ l`/ `` / r. oU N e. 00 o 24 Effective at THE ACCESS COVERS FOR THE SEPTIC TANK, i. CONCRETE FULL FOl1NDATl ; H-10 II f; r y - �S{O►ewald ';; DISTRIBUTION BOX AND LEACHING COMPONENT �j co ao 4' 4' ,� s e 7,33' 36.6 ,,r SHALL BE RAISED TO WITHIN 6" OF e In.oi 3/4'-1 1/2' it J--L!�36.65 - �, ' FINISHED GRADE. _ SYSTEM PROFILE > ° 12' II 'STEEL REINFORCED PRECAST CONCRETE INSTALL TUF-TITE GAS BAFFLES OR EQUALS 92ooaldLowaoRaep®208enivlEo_.wa z > y Effective Width ON ALL OUTLET TEE ENDS compacted stone Not to scale - e o 4.65 c c � >6 Effective Length PLAN VIEW 8 in.of 3/4'-1 1/2' m SOIL ABSORPTION SYSTEM (SAS) GENERAL NOTES compacted stone � 3-24" REMOVABLE COVERS 1. Contractor is responsible for DI safe notification, Verification of Utilities NOTE: ALL COMPONENTS MUST HAVE RISERS TO W/IN 6" OF GRADE Lai INFILTRATOR MODEL. 3050 (H-20 LOADING)/ SUMNER & DUNBAR ` P 9 Bottom of Test Hole 1 Elev.-81.00 (OR EQUIVALENT) INLET and protection of all underground utilities and pipes. •.;.,,, ;•. +• 2. The septic*tank / j distri4L{tion box shall be set Obs. Groundwater - Test Hole 1 EIev.= NONE OBSERVED NOTE: OVERALL HEIGHT OF INFILTRATOR IS 30" /EFFECTIVE HEIGHT IS 24' 3 min. dearance 7 level on 6 of 3/4 -1 1�/2 stone. • ? m�T_L_min. Inlet to outlet e.�„ .' 'r s 3. Backfill should be clean sand or gravel with no 1 i to.n,n ITTdT.v.l OUTLET stones over 3" in size. s-r * - �S s -r 4. This system is subject to inspection during installation $ +,-o• min. by Carmen E. Shay - Environmental Services, Inc. 0.soft Liquid depth 5. The contractor shall install this system in accordance y with Title V of the Massachusetts state code, the approved plan and Local Regulations. 6. If, during installation the contractor encounters any PROJECT BENCH MARK W-O" 8' -a. soil conditions or site conditions that are different TOP OF FOUNDATION CROSS SECTION END-SECTION from those shown on the soil log or in our design ELEV. = 100.00 (Assumed) c!Icp installation must halt do immediate notification be -41 Ct made to Carmen E. Shay - Environmental Services, Inc. 1 1 `� Failed 7. No vehicle or heavy machinery shall drive over the I Cesspool PERCOLATION TEST septic system unless noted as H-20 septic components. 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. ` Failed I 126.83' i I �\ NEW 9. All Distribution Lines shall be 4" diameter Sch. 40 NSF PVC pipes. Cesspool I Failed 1 1500 GALLON Date of Percolation Test: AUGUST 3, 2006 l ` I H-10 SEPTIC TANK Test Performed By. CARMEN E. SHAY, R.S., C.S.E. 10. All solid piping, tees dt fittings .hall be 4" diameter I Cesspool _ Results Witnessed B DONALD DESMARAIS BARNSTABLE BOH W i - , Y ( ) Schedule 40 NSF PVC pipes with water tight joints. I O t\ D-Box Excavator: SHAY ENVIRONMENTAL SERVICES, INC.1 ---� Percolation Rate: 2 min./Inch 0 48" BELOW GRADE. 11. SITE and Surrounding Properties are Connected TEST HOLE #1 to Municipal Water. ELEV.= 92.00 Test Hole Test Hole EXISTING DECK �\ { No. 1 No. 2 4 BEDROOM DEPTH SOILS ELEV. DEPTH SOILS ELEV. 'S• 0 92.00 0 92.00 THE PROPERTY LINES ARE APPROXIMATE AND HOUSE vi~ COMPILED FROM THE SURVEY PLAN GENERATED BY 137 WALKOUT ED KELLOG, CIVIL ENGINNER OF CENTERVILLE, MA ENTILTED"BASEMENT 22 g� r•, .� ' 4+ 0"- FILL 12' 91.00 FILL 0'-12" 91.00 SUBDIVISION PLAN OF LAND iN CENTERVILLE, MA of IDA HINCKLEY, Sandy Loom Sandy Loom DATED NOVEMBER 3, 1952, PLAN BOOK 107, PAGE 5 and THE DEED 10YR 3/2 10YR 3/2 IT SHOULD BE USED FOR NO PURPOSE OTHER THAN THE SEPTIC SYSTEM INSTALLATION. Ii ha TEST HOLE #2 12'-16' As 90.50 12'-18" As 90.50 ELEV.= 92.00 Sandy Loam Sandy Loam EXISTING CESSPOOLS TO BE PUMPED OUT AND REMOVED 10YR 5/6 10YR 5/6 18'-48" Bw 88.00 18"-48" Bs 88,00 ' .. f / f W tom• 0 O �p --r-- W d >4. �0 z' t'� Medium Medium NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE - 1 / / EXISTING ` ' w sand sand DRIVEWAY 2.5 Y 7/4 2.5 Y 7/4 FROM THE EXISTING CESSPOOLS TO BE DISPOSED 4" PVC 48"-132" CI 81.00 48"-132" CI 81.00 OF AS PER BOARD OF HEALTH SPECIFICATIONS. VENT / ' - L__�f'' Z \ ASSESSORS MAP 208 PARCEL 094 r-- ` ` �\ N/F CHARLES VAQUITH ZONING - RESIDENTIAL _ N/F E.T. CHESTER ��\ LOT # 3 EXISTING --94 Perc #1 FLOOD ZONE C HOUSE # 137 1 BEDROOM Depth R 2 thto P c 8„m n /inch 17,250 Square Feet +/- COTTAGE BOTTOM OF Groundwater TEST Not Observed ev. 132 ' " ARE NO WETLANDS LOCATED WITHIN A 200 RADIUS ADJUSTED H2O Elev. No Adjustment-Required. EXISTING DRIVEWAY_ j LEGEND ALL OUTLET PIPES FROM THE -9 ' ' DISTRIBUTION BOX SHALL BE t2' _---_---- � ' CONCRETE COVER � ------------- --�- SET LEVEL FOR AT LEAST 2 FT. 1/.. .• 1 . 3- s"OUTLET v .,r', .e..� 2 CPO 106.83 XNoa(OUTS 0o I ' � t 8X0 DENOTES PROPOSED - - a.s' OunET 12' 14LU SPOT GRADE eq S. - M1d DENOTES EXISTING I y x 104.46 SPOT GRADE ( � PLAN SECTION CROSS-SECTION PL I � I PROPERTY LINE 3 HOLE DISTRIBUTION BOX - H-10 LOADING - PROPOSED CONTOUR NOT TO SCALE 1 I : 97- - -- - -97 EXISTING CONTOUR I II lu IT o ® DEEP TEST HOLE & I L- PERCOLATION TEST LOCATION I I LOT # 2 Design Calculations I y Number of Bedrooms: 5 Equivalent to 550 Gal./Day (330 Gal./Day Min. per Title V) FENCE I. Garbage Grinder: No I L) Leaching Capacity Proposed: 550 Gal./Day Minimum (Min. Per Title V) I Septic Tank : - 2 x 550 Gal./Day= 1100 USE NEW 1500 GAL Septic Tank. PRIVATE DRINKING WATER WELL I 1 SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch REVISIONS Bottom Area: 0.74 gal/sq. ft. x 528 sq. ft. = 390.72 gallons I I Sidewall Area: 0.74 gal./sq. ft. x 224 sq. ft. 165.76 gallons I I I Providing: 556.48 gallons N0. DATE: DEFINITION Use: (5) 3050 H-20 INFILTRATOF, CHAMBERS, HAVING A 2' EFFECTIVE DEPTH, I I '4' W x 7' L) TO BE USED WITH 4' OF WASHED STONE ON THE SIDES AND 4' OF WASHED STONE ON THE ENDS. I � I I I I I . I I i I -� I I i PROPOSED LOT # 1 PREPARED FO R : SUBSURFACE SEWAGE DISPOSAL SYSTEM I , ; OF I II ROBERT DAVALOS # 137 MAIN STREET 10.20'1 --- I I # 137 MAIN STREET CENTERVILLE, MA ---------__ CENTERVILLE, MA PREPARED BY: r A)?ffEy E. SffA Y CAR oyt � ENVIRONMENTAL SERVICES, INC. E ----__--- H P.O. BOX 627 --_--- o 0 20 40 50 EAST FALMOUTH, MA 02536 - ----- ___ `�a,sTE�� TEL/FAX . 508-539-7966 SCALE: 1 "=20' DRAWN BY: CES DATE: AUG. 17, 2006 PROJECT#SD-957 FILENAME: SD957PP.DWG SHEET 1 OF 1