Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0156 OLD STAGE ROAD - Health
.156 OLD STAGE ROAD, CENTERVILLE A= 209 069 l% O �J�QECCIFp;,, UPC 12543 ° No. 53LOR HASTINGS.Ml I j No. ,� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2ppliLAtion for Mispo', Llft'Btpm Construction j3Prmit Application for a Permit to Construct( ) Repair( ) "gr`ade( Abandon( ) ❑Complete System El Individual Components Location Address or Lot No. 1510 C iL t Owner's NajAe,Address,and Tel.No. Ge tf'Ce s�J(°ll , Mj lot�e�� Q lxs +�5 Assessor'sMap/Parcel JC16 h L ,e `��� (' a-If a InsUllller's Name ddress and Tel No. 5G �'"�$�a .Designer's Name Address and Tel.No.`56 "%3 —O© b.ery ,'f�,oulz ED ':5P3 c. Type of Building: Dwelling No.of Bedrooms y Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requir d) q 0 gpd Design flow provided y , q L gpd Plan Date 1'D I Number of sheets C1 Revision Date Title Size of Septic Tank Type of S.A.S. UU q0Z. Description of Soil rA- R06'►`Z A" "��A.ar�y nn AQ c a_DA)" P)A M� SA► 0 C 1 {'��Pi�r�t✓ Nature of Repairs or Alterations(Answer when applicable) 0 5Ta I a 1 5 f�A (A lrt(. at,> T t j ,D— I Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed / Date Application Approved by Date I c 1 Application Disapproved by Date for the following reasons Permit No. ��'""' Date Issued ct 'a ' ti'.r"+..p"`.'.�`..n .'».`e��.'. ^ram"'.. I- .. . .,.,,, .I • . �`p ,p ^1 YLr? No. �D Fees /00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION --TOWN OF BARNSTABLE,,MASSACHUSETTS Yes 4plitation for Mispo •: Btpm ConstrUttiott permit Application for a Permit to Construct( ) Repair( ,) � grad ) bandon( ) ❑Complete System -❑Individual Components Location Address or Lot No. 1510 OL N V Owner's N e,Address,and Tel.No.5 vas-6y�y'�bOa., Ger�T��OlE'� �tt CeNDUU+6�'S Assessor's Map/Parcel 04/ - - k, L r _ AGUE �d. CPA-('t u l 11 v2 Installer's Name,Address,and Tel.No. 56%- q 3 a'OS30 Designer's Name LA'dress and Tel.No.s0i-%3 -�to q I } leo5gc-r rJ,OUR Co -TAC VH A550�4.q e}' yP,a off; AQtu1Cb AA . D S-310 C -7iV -t r�. S nlc�wltl+ Ct U 5in3 Type of Building: n, s' Dwelling No.of Bedrooms L4 Lot Size /( t sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Q� I Design Flow(min.required) 40 gpd Design flow provided y O , L gpd Plan Date i I Number of sheets Revision Date Title ' Size of Septic Tank 1500 Type of S.A.S. ( Qn G at • 6"R Description of Soil - kpr► A p/� a S A lid L nn , B. Ho f 12bA }- 00 A M,4 SA 1,0 C C,Porn.jw coACSQ ��ad Nature of Repairs or Alterations(Answer when applicable) n)�?'4 L L 1502 Ci&LLca N TA AI l/ i � 911�)l. (3) S Le t3►C.1A j,.ac, CL►><am lie Date last inspected: Agreement: The undersigned agrees to-ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. p Signed _ Date _` I 1 .. Application Approved by 4�. _ Date t ' Application Disapproved by Date for the following reasons Permit No. r~ Date Issued Q 'C 1 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certifitate of Compliance THIS IS TO CERTI Y,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by o u rt C O a :rtj e, - at (o C)LID �A4,0, C (�-has,been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated Installer QQ_h-R c`r B .()U R C Designer 1/9 AS_S0G*l Q Te " #bedrooms IV Approved design flow —11i0 r gpd The issuance of this permit ll i shall of be construed as a guarantee that the syste i wlI 'on • si�. �/Date f J �� Inspector _ - — -------- - -. _ . . ... No. Fee ! 6 0 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS MispoBal *pstem.ConstrUttion i9ermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) ty System located at 1 5(£, O L D 5j7r � '� A`&, Ce N"ft'c V I f `P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date �-' Approved byy ..,, , Town of Barnstable Regulatory Services • �'� _ Richard V. Scali,Interim Director • nnnxsrnsLe. ' MASS �0 Public Health Division 1639. ° TJ,,nmas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: _z_Q Sewage Permit#,I ' Assessor's Map\Parcel A�f Designer: aAs Atyal°S Installer: Address: -3y0 (, /W AW Address: u�GG�L ow On 106 I R_ �. AZl!'GO lilt- was issued a permit to install a (date) / (installer septic system at 4f' based on a design drawn by (a d ess) dated (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the approval letters (if applicable) crMAss9 a AW (Installer's Signature) VON HONE �+ v 9 #1068 a y 4 �A Designer's Signature) (Affix 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:\Septic\Designer Certification Form Rev 8-14-13.doc j TOWN OF BARNSTABLE LOCATION 10 O SIP �p`& SEWAGE # Q- o Vj'' LAGE 11 ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO.?S-626� IJ~ (12-(L e® &-qS4'M30 SEPTIC TANK CAPACITY S bo a o,L - LEACHING FACMITY: (type SQD Q Q1• dAA%,aer (size) -�,3 K X a, NO. OF BEDROOMS BUILDER OR OWNE L ¢ PERMITDATE: d �i COMPLIANCE DATE: /4 t3 h O Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility &J(44 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 l Feet within 300 feet of leaching facili Furnished by // i i D j i 6 �3t - 3 3 9 TI Q a TOWN OF BARNSTABLE LOCATION pz�? SEWAGE# VILLAGE ' ASSESSOR'S MAP&PARCEL :;2 INSTALLERS NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) Q. (size) , h YR NO. OF BEDROOMS OWNER 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 I �� �� 13�fk e ��vs� I' i b i � � 1 THE Town of Barnstable Barnstable Regulatory Services Department AFAmedcaC j BARNSCABM " I Public Health Division Cb i6gq. 10 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4990 5718 August 13, 2018 POWERS, EILEEN F 156 OLD STAGE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 156 Old Stage Road, Centerville, MA was inspected on 07/10/2018 by Reid C. Ellis, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Discharge or ponding of effluent to the surface of the ground. 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 TH BOARD OF HEALTH omas ean, R.S., CH Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\156 Old Stage Road Centerville.doc t►+E loy,o Town of Barnstable anxivsrnBi.e. Regulatory Services Department AlED MAC A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44-and Title V: 310 CMR 15-000) An"x" marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER 969:��t v AC it tl Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Formx Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r= f .. 156 Old Stage Road, Centerville, MA Property Address F i3O Eileen F. Powers Owner Owner's Name T information is Centerville MA 02632 07/10/2018 r ''required for every - page. Cityrrown State Zip Code Date of Inspection :. Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms 614p 1 3 al-1, on the computer, use only the tab 1. Inspector: key to move your cursor-do not REID C. ELLIS use the return Name of Inspector key. ELLIS BROTHERS CONSTRUCTION „y Company Name 23 ENTERPRISE ROAD Company Address YARMOUTH PORT MA 02675 Cityrrown State Zip Code 508-362-6237 S121891 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes ❑ Conditionally Passes Fails ❑ Needs Further Evaluation by the Local Approving Authority Ins cto►'s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc-rev.6f16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 117 B��YaI commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F_ Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: /W ❑ 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: B) System Conditionally Passes: �A ❑ One or more system components as de acribed 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 determ ed"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years Id*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or a titration or tank failure is imminent. System will pass inspection if the existing tank is replaced wit i a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if il is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less tf an 20 years old is available_ ❑ Y ❑ N ❑ ND(Explai below): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection --------------------- B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operate al.ystem will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break o 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 o Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replac d ❑ 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 approv I of the Board of Health): El broken pipe(s)are replaced ElY ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the oa of Health: ❑ Conditions exist which require further evalua Ion by the Board of Health in order to determine if the system is failing to protect public health, E afety or the environment. 1. System will pass unless Board of Healt I determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioi iing in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of surface water ❑ Cesspool or privy is within 50 feet of bordering vegetated wetland or a salt marsh t5ins.doc•rev.6/16 dfe 5 Official Inspection Form:Subsurface Sewage Disposal System.Page 3 of 17 Commonwealth of Massachusetts Title 5 Official c al Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of ealth(and Public Water Supplier, if any) determines that the system is function ng in a manner that protects the public health, safety and environment: El The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tribu ary to a surface water supply. ❑ The system has a septic tank and SA and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SA 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: *x This system passes if the well water analys s, 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 f 3ilure 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 dLiquid depth in cesspool is less than 6"below invert or available volume is less than %day flow t5ins.doc-rev.6/16 Tale 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. City/Town state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ Vtributary to a surface water supply. 1 Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ Any Portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Bo rd of Health to determine what will be necessary to correct the failure. r E) Large Systems: To be considered a large syste the system must serve a facility with a A/M design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"o "no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet M a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Z ne II of a public water supply well If you have answered"yes"to any question in Secti n E the system is considered a significant threat, or answered"yes" in Section D above the large sys em has failed. The owner or operator of any large system considered a significant threat under Sectio i E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The s stem owner should contact the appropriate regional office of the Department. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection C. Checklist I Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No V❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? ❑ Were all system components,%xcluding the SAS, located on site? ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and-location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Informatio Residential Flow Conditions:t�.4 c-e rs., L / � Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): r7 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal S 9 Po ystem•Page 6 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: d Number of current residents: Does residence have a garbage grinder? ❑ Yes V_ N Is laundry on a separate sewage system?(Include laundry system inspection El Yes information in this report.) Laundry system inspected? ❑ Yes N Seasonal*use? ❑ Yes j No Water meter readings, if available(last 2 years usage(gpd)): Detail: A--. Sump pump? ❑ Yes No Last date of occupancy: Date Commercial/industrial Flow Conditions: � - Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 sy tem? ❑ Yes ❑ No Water meter readings, if available: t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts y Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owners Name information is required for every Centerville MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? Yes ❑ No If yes, volume pumped: SO/ gallons �� �How was quantity pumped determined? a a Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system Single cesspool Overflow cesspool 14 —144* ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 1 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is Centerville required for every MA 02632 07/10/2018 page. Clty/Town State Zip Code Date of Inspection 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 [ No Building Sewer(locate on site plan): Depth below grade: feet Ma/terial of constructiW M cast iron PVC El other(explain): L Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): �S t � A Y Septic Tank(locate on site plan): Depth below grade: feet Material of construction: concrete ❑ metal ❑fib rglass ❑ polyethylene Y ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance (attach a copy of certificate) ❑ Yes ❑ No Dimensions: Sludge depth: t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is Centerville required for every MA 02632 07/10/2018 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or t affle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee r 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): sue' Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or I affle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins.doc•rev.6116 ifie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts "title 5 Official Inspection Form 0 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner information is owner's Name required for every Centerville MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) ��� Comments(on pumping recommendations, inle and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence f leakage, etc.): Tight or Holding Tank(tank must be pumped t time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fib r9 lass El 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 switche , etc.): "Attach copy of current pumping contract(requ'red). Is copy attached? ❑ Yes ❑ No I t5ins.doc-rev.6116 Tive 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts R Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owners Name information is required for every Centerville MA 02632 07/10/2018 page. Cltyrrown 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 14129 Comments(note if box.is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): d Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamb r, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order,'system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins.doc-rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is Centerville required for every MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type �!'aiJl�7� ��df/�,�✓� � �'��� ��� leachingits P number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Cesspools c ool must be pumped s 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 rS � Dimensions of cesspool . Materials of construction ' Indication of groundwater inflow ❑ Yes � No t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Dis g posal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of by/raulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of t ydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form N Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is required for every Centerville MA 02632 07/10/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate 7wh re public water supply enters the building. Check one of the boxes below: hand-sketch in the area below drawing attached separately 1�p 'Af r -? t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is Centerville required for every MA 02632 07/10/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope 4v�e—�• ❑ Surface water AI/7AIe' ❑ Check cellar e,4 f-L,- 4e-UAA- 4- AM yG�1 ❑ Shallow wells 4114 Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site.(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Before fling this Inspection Report,please see Report Completeness Checklist on next page. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Road, Centerville, MA Property Address Eileen F. Powers Owner Owner's Name information is Centerville required for every MA 02632 07/10/2018 page. Cltyfrown State Zip Code Date of Inspection E. Re ort Completeness Checklist nspection Summary:A, B, C, D, or E checked nspection Summary D(System Failure Criteria Applicable to All Systems)completed ystem Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 '7 Town of Barnstable .. P# $ Department of Regulatory Services s , arts r' Public Health Division DateMAM �" 9 eyy 200 Main Street,'Hyannis MA 02601 Date Scheduled t / Time l Fee Pd. d D rGl' Soil SuitablVity Assessment for S Disposal ' Performed By: / / U� �dL_ Witnessed B y y: LOCATI & GJPNERAL INFORMATIO Location Address ��O ® f Owner's Name ! ��� Address G 0� Assessor's Map/Parcel: /`q O / / Engineers Name NEW CONSTRUCTION REPAIR Telephone# Land Use 4S( 1°h�Q/ Slopes(°!o) Surface Stones Distances from: Open Water Body ft Possible Wet Area ft Drinking Water Well ft Drainage Way ft Property Line 14� ' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) /o�.� r# L4 t Parent rr�terial(geologic) Depth to Bedrock zz n Depth to Groundwater: Standing Water in Hole:.__`, Weeping from Pit Face I✓ Estimated Seasonal High Groundwater DETERNIINATION FOR SEASONAL HIGH WATER TABLE Method used: Depth Observed standing in obs.hole: 1A in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index We] evel Adj.factor Adj.Groundwater Level PERCOLATION.TEST Date 7 " Ot'lme 07 Observation Hole Time at 9" # Depth of Perc -f6 /� Time at 6" ` 9" ) Start Pre-soak Time @ Time( .� / �., End Pre-soak /d/ fI r/J��o Rate MinAnch Site Suitability Assessment: Site Passed 1/ Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. nsigm ° graven /0 "' 2 • • a1 a � r - � 't r - D t DEEP OBSERVATION HOLE LOG Hole#_ Depth from 'Soil Horizon Soil Texture soil Color Soil Other Surface(in.)r (USDA) (Munsell) Mottling (Structure,Stones,Boulders. sistenc ° Gravel) z 1-SA6 vfl,.>— _7w /Vo DEEP OBSERVATION HOLE.LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color soil Other Surface(in.) (USDA) (Mansell)_ Mottling (Structure,Stones,Boulders. consistency,° Grav FloodInsurance Ratg M$,ps r Above 500 year flood boundary No Yes Within 500 year boundary No L,-" Yes Within 100 year flood boundary No C"' Yes Death of Naturally Occurdng�Pe_erw*ous Material Does at least four feet of naturally occurring perviou material exist in all areas observed throughout the area proposed for the soil absorption system? t S If not,what is the depth of naturally occurring peMous material? Certification I certify that ondate)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature / Date Q:\SEMC\PERCFORM.DOC Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information W forms the ( 1L O computer, r, use 1. Inspector: I �}} only the tab key to move your Raymond F. Dumas, Jr. cursor-do not Name of Inspector use the return key. Dumas Landscape Const. Inc. Company Name 564 Old Stage Rd. AA Company Address Centerville, Ma. 02632 ' Cityrrown State Zip Code 508-778-0249 S 1437 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this addressland that he information reported below is true, accurate and complete as of the time of the inspection. T�inspection was performed based on my training and experience in the proper function and maidtenancq--�f on-site sewage disposal systems. I am a DEP approved system inspector pursuant to, 'ction 1 340"' Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fail ❑ Needs Further Evaluation by the Local Approving Authority E> ca w r— ©9 Inspec ors Ignature Date The system inspector shall submit a copy of this inspection report.to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. LDt /d /a 1 Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Answer yes, no or not determined (Y, N, ND) in the ❑for the following statements. If"not determined," please explain. ❑ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND Explain: ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed Title Five Inspection Forms 08.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/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. Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection C. Che cklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? E ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2007/70000 2008 9 ( Y 9 (gpd)): /8000 Sump pump? ❑ Yes ® No Last date of occupancy: 2008 Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Barnstable Waste Facility Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 galgallons How was quantity pumped determined? estimate Reason for pumping: Required for cesspools Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: not known Were sewage odors detected when arriving at the site? ❑ Yes ® No Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wti , 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: Winches feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: 6 ft. feet Comments(on condition of joints, venting, evidence of leakage, etc.): look good Septic Tank(locate on site plan): Depth below grade: no septic tank feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Title Five Inspection Forms 08.doc-03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Title Five Inspection Forms 08.doc-03108 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ® No Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert no d box Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 2 ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °�M s 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Depth—top of liquid to inlet invert 30 . Depth of solids layer 6" inches Depth of scum layer none Dimensions of cesspool #1 5'x6'#2 6'x8' Materials of construction Block Indication of groundwater inflow ❑ Yes ® No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Title Five Inspection Forms 08.doc•03108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts ' Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/1&,'- 9 — every page. CitylTown State Zip Code Date of tx f , D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a.s; of the sewage disposal system including ties to at least two permanent reference landmarks wr b4nch rks. Locate all wells within 100 feet. Locate where public water supply enters the building t ,rMh� 51;k C- L R�I ?Vd 7 4 { Tom.F�A' txs E�GBjdb,'.. r �� rn�• "�'W k„s ,�3t " Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments wM 156 Old Stage Rd. Property Address Robert Pyke Owner Owner's Name information is required for Centerville Ma. 02632 3/16/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 14 ft+ 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: 11/20/97Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: Plan Dated 11/20/97 for 21 Old Post Rd ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Title Five Inspection Forms 08.doc•03/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 r � � � 1/o� COMMONWEALTH OF MASSACHUSETTS F EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION _ Property Address: 15 lP ati- Owner's Name: ' Owner's Address: cam . Date of Inspection:�— �/-- U e Name of Inspector:( ease print)_ a/-94/yY,*5 L+l J Company Name: rn Mailing Address: - Telephone Number: c O S—-7 7 E? —U-2 1 � 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 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: t/Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails hnspector's Signature: t/.I_.Daev_� .. M. : 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 R ' r Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: /S<o Owner: Date of Inspectio : 02 — `/ D (o 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: 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. IVZ The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: G� 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: 4�9 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: 15-6 Owner: Date of Inspection: — `/—U(I 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 Boa of He h determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a a er which will protect public health,safety and the environment: _ Cesspool or privy is wi 50 et of a surface water _ Cesspool or privy is wi 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 d SA and the SAS is within a Zone I of a public water supply. The system has a septic tank SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic and S and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. ethod use to determine distance **This system passes if the ell water alysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic com 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: I/�6 Owner: _ Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No L Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool D iscbarge 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 1/) Liquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow ,d O Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped &D Any portion of the SAS,cesspool or privy is below high ground water elevation. -(p Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. , o Any portion of a cesspool or privy is within a Zone 1 of a public well. L/ Any portion of a cesspool or privy is within 50 feet of a private water supply well. 4y& 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 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.] lVo (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 larg systems in addition to the criteria above) yes no the system is within 400 feet o a surf¢e�drinking water supply the system is within 200 feet of ibutary to a surface drinking water supply the system is located in a ' ogen sense've area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public wat supply well If you have answered"yes"t any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the arge 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 CUR 15.304.The system owner should 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: Owner: . Date of Inspectio : Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No Pumping information was provided by the owner,occupant,or Board of Health Were any of the system components pumped out in the previous two weeks Has the system received normal flows in the previous two week period 1, Have large volumes of water been introduced to the system recently or as part of this inspection N0r14✓ Were as built plans of the system obtained and examined?(If they were not available note 7A t� 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: Yes no _.ZExisting information.For example,a plan at the Board of Health. 1� Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] Title 5 Inspection Form 6/15/2000 5 r . t Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: (, K Owner: Date of Inspection: a (o FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Number of current residents: Does residence have a garbage grinder(yes or no):-4yj' Is laundry on a separate sewage system(yes or no):-/&[if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):JUO Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no): NO Last date of occupancy: S�/°1- ,400 COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 Pv1R 15.203): gpd Basis of desi ow(se persons/sgft,etc.): Grease trap pres t s or no): Industrial waste g tank present(yes or no):_ Non-sanitary to charged to the Title 5 system(yes or no):_ Water meter r adings,i ailable: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: I�/hZNS T-N-Q 1 E 5ewA Lrj a PZ A r/t' —nx/6-- v y Was system pumped as part of the inspection(yes or no):�/�5 If yes,volume pumped: , l V allons--How was quantity pumped determined? Sr1,�y�T�C Reason for pumping: _ TD 10t5-Tg42/n..-, oR i .4,6vo /�/✓� CO.r/�� i v>rJ ,t S T.Q✓G 7-7J,2 S TYPE OF SYSTEM Se tic tank,distribution box,soil absorption system Se cesspool _4,,0verflow cesspool —Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) —Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copy of the DEP approval —Other(describe): Approximate age of all components,date installed(if known)and source of information: _AA;p- /cn/drun• Were sewage odors detected when arriving at the site(yes or no):AO Title 5 Inspection Form 6/15/2000 6 5 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: /6-2t 67-9e-C Owner: Date of Inspection: a - q-o k BUILDING SEWER(locate on site plan) Depth below grade:_ Materials of construction:41-9s�t iron _40 PVC_other(explain): Distance from private water supply well or suction line: No 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 age c ed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top sludge to bottom of outlet tee or baffle: Scum thickness- Distance fro top of sc to top of outlet tee or baffle: Distance m bottom o scum to bottom of outlet tee or baffle: How were ' ensions 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 construction:_concr tee_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top oksctot op of outlet tee or baffle: Distance frombottto bottom of outlet tee or baffle: Date of last pump' g: Comments(on 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 f Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �✓'�� � � � .�� Owner: �1y[c✓r,o Date of Inspection: 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;(yes allons/day Alarm presenAlarm level: in working order(yes or no): Date of last pComments(c of alarm d float switches,etc.): DISTRIBUTION BOX._(if presenfmust be opened)(locate on site plan) Depth of liquid level above et invert: Comments(note if box i ev and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of ox,etc.): PUMP CHAMBER: (locate on site plan),: Pumps in working order(yes)noAlarms in working order(yes ' Comments(note condition of hamber,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��IIN-FORMATION(continued) Property Address: Owner: Date of Inspection: SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:_ leaching chambers,number:_ leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number:_ innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: 02 Depth-top of liquid to inlet invert: o " �Ft" Ne's r- ,ix/ve,e T i i!l F�iC s 7-c�ss�vo! Depth of solids layer: /,?/' iN f. s7- c Ess ice/ Depth of scum layer: 4,- iN F.R5, - Dimensions of cesspool: 4A0-0 d u vet o° Y C�iX 5T e.Cs s Rood Materials of construction: 0 L v ck Indication of groundwater inflow(yes or no):-, Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): C,6�-5s'00000L ,z i�P o >< u�.r�� x 0 D-MTh Ao�r4 e�ss ,�oo�-s cd�+e� �vr�f'�v �T Ti'�as� d.� !✓s�'�c�i orcJ PRIVY: (locate on site plan) Materials of construction: Dimensions: . Z Depth of solids: Comments(note c tion 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 Inspectio ,-4 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. OtD �14G Ed I' 0L0 F05 r R�I �i d� 2Y 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: J51 ae Owner: Date of Inspectio : y U 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) 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: G S 1,o7,,5* ' aAf —7-o w ltl ul4rzi 5-7 Title 5 Inspection Form 6/15/2000 11 v M Commorwvedth of Mossochusetts John Grad ExeeutNe Ofte of ErMrorrmnfal Affdrs D.E.P. Title V Septic Inspector Department of P.O. Box 2119 Teaticket, Envronrnental Protection 5 (sox - 36 133 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM RECEIVED PART A CERTIFICATION BAR 1 1997 T01WN Property Address: 166 Old Stage Rd. Centerville Address of Owner: �� 11fA1 NDEpp8LE Date of Inspection:7128197 (if different) Name of Inspector:John Graci Mr.Sullivan P Company Name,Address and Telephone Number: 6 g 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 This Inspection Is based on criteria defined in Title V _ Conditionally Passes code 310 CMR 15.303.My findings are of how the system is Needs Fvrthel Evaluation B the Local Approving Authority performing atthe time of the Inspection.My Inspection does Y PP 9 tY not Imply any warranty or quarantee of the longevity of the Fails septic system and any of its components useful life. Inspector's Signature: Ali Date: 319197 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspections. 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. INSPECTION SUMMARY: Check A, B,C, or D: A] SYSTEM PASSES: X I have not found any information which indicates that the system violates any of the failure criteria defined as in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: One or more system components need to be replaced or repaired. The system, upon completion of the replacement or repair,passes inspection. Indicate yes,no,or not determined(Y, N,or ND). Describe basis of determination in all instances. If "not determined", explain why not.) The septic tank is metal,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 conforming septic tank as approved by the Board of Health. (revised 11115195) One Winter Street • Boston,Massachusetts 02108 • FAX(617)556-1049 • Telephone(617)292-5500 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 155 old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:2f28197 _ Sewage backup or breakout or high static water level observed in the distribution box is 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 leveled or replaced _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 Cl 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 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 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 APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system and is within 100 feet to a surface of water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and is within 50 feet of a,private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria volatile organic compounds indicates that the well is free from pollution for that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal or less than 5 ppm. 3) OTHER D) SYSTEM FAILS: _ I have determined that the system violates one or more of the following failure criteria as defined 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. _ Backup of sewage in facility or system component due to an 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 Cesspool. SAS is In hydraulic failure. (revised 11115195) 2 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 156 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:2128107 D)SYSTEM FAILS(continued) 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. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Numbers of times pumped Any portion of the Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E] LARGE SYSTEM FAILS: The following criteria apply to large systems in addition to the criteria: 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: the system is within 400 feet of a surface drinking water supply _ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(interim Wellhead Protection Area (IWPA)or a mapped Zone it of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further Information. (revised 11115145) SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECLIST Property Address: 156 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:2128197 Check if the following have been done: X Pumping information was requested of the owner,occupant,and Board of Health. X None of the system components have been pumped for at least two weeks and the 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. NaAs 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. X The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. X The facility owner(and occupants,if different from owner)were provided with information on the proper maintenance of Sub- Surface Disposal System. (revised.11115195) 4 I ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 156 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:7128197 FLOW CONDITIONS RESIDENTIAL: Design flow: 0 gallons Number of bedrooms: 4 Number of current residents: 0 Garbage grinder(yes or no): No Laundry connected to system(yes or no): No Seasonal use(yes or no): No Water meter readings,if available: n1a Last date of occupancy: 2 years a o COMMERCIALIINDUSTRIAL: Type of establishment: n1a Design flow:0 gallons/day Grease trap present:(yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system:(yes or no) N0 Water meter readings,if available: n1a Last date of occupancy: n1a OTHER:(Describe) Ma Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System has not been pumped in the last two years. System pumped as part of inspection: (yes or no)No If yes,volume pumped: 0 gallons Reason for pumping: n1a TYPE OF SYSTEM Septic tank/distribution box/soil absorptions system X Single cesspool X Overflow cesspool Privy Shared system(yes or no) ( if yes,attach previous inspection records,if any) Other(explain) APPROXIMATE AGE of all components,date installed(if known)and source information: 30+years Sewage odors detected when arriving at the site: (yes or no) No (revised 11115195) I 5 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 156 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:2128197 SEPTIC TANK: (locate on site plan) Depth below grade: rda Material of construction:X concreate_metal_FRP_other(explain) Dimensions: nla Sludge depth:nla Distance from top of sludge to bottom of outlet tee or baffle: n►a Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:rda Distance form bottom of scum to bottom of outlet tee or baffle:nla 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 GREASE TRAP: (locate on site plan) Depth below grade: nla Material of construction: —cone rete_metal_FRP_other(explain) Dimensions: nla Scum thickness:nla Distance from top of scum to top of outlet tee or baffle:rda Distance from bottom of scum to bottom of outlet tee or baffle: nla 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 11115195) ti SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 150 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:?JY8197 TIGHT OR HOLDING TANK: (locate on site plan) Depth below grade: n1a Material of construction:_concrete_metal_FRP_other(explain) Dimensions: n1a Capacity: n1a gallons Design flow: n1a gallons/day Alarm level: nla Comments: (condition of inlet tee,condition of alarm and float switches,etc.) n1a DISTRIBUTION BOX: (locate on site plan) Depth of liquid level above outlet invert: n1a Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box etc.) n1a PUMP CHAMBER: (locate on site plan) Pumps in working order.(yes or no) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) n1a (revised 11115195) 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 155 Old Stage Rd.Centervitle Owner: Mr.Sullivan Date of Inspection:2128197 SOIL ABSORPTION SYSTEM(SAS):X (locate on site plan,if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: n1a Type: leaching pits,number: n1a leaching chambers,number:n1a leaching galleries,number: n1a leaching trenches,number,length: n1a leaching fields,number,dimensions:n1a overflow cesspool,number:6'x6'block Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The overflow was empty at the time of the inspection it is structurally sound. CESSPOOLS. X I, (locate on site plan) Number and configuration: one Depth-top of liquid to inlet Invert: empty Depth of solids layer: 9 Depth of scum layer: 9 Dimensions of cesspool: 414' Materials of construction: block Indication of groundwater: none inflow(cesspool must be pumped as part of inspection) n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) Main cesspool and all components are structurally sound Recommend pumping system every year for maintenance. PRIVY: (locate on site plan) Materials of construction: n1a Dimensions: n1a Depth of solids: n1a Comments:(note condition of soil,signs of hydraulic failure,level of ponding, condition of vegetation,etc.) nla (revised 11115195) 8 t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 156 Old Stage Rd.Centerville Owner: Mr.Sullivan Date of Inspection:2128197 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I b DEPTH TO GROUNDWATER Depth to groundwater:12 feet method of determination or approximation: t1SGS Maps and Charts:Note,we do not verify lot lines. (revised 11115195) 9 jt .t Oio Great Marsh Rd ASSESSOR'S MAP: 209 GENERAL NOTES: LOCUS `Sr4 PARCEL: 069 9� REFERENCE: PL. BK. 162 PG. 133 1. VERTICAL DATUM: __ASSUMED -------- .p Route 28 • ' PL. BK. 152 PG. 33 2. MUN�lPAL, WATER --IS —_ AVAILABLE. v w _ 3. SCHEDULE 40 PVC PIPE TO BE USED THROUGHOUT Route O FLOOD ZONE:__. X Town of Barnstable SIRSTEM ,UNLESS OTHERWISE NOTED. O\6 pos #25001C0563J(07/16/14) 4. ALL PRECAST UNITS TO CONFORM TO Fuller Rd AASHTO: _H_10 & 20 Q I 5• PIPE PITCH-1/4" PER FOOT UNLESS OTHERWISE NOTED. CD S� i 6• ALL CONSTRUCTION DETAILS TO BE IN CONFORMANCE Q WITH MA ENVIR. CODE (TITLE 5) AND LOCAL REGULATIONS. LOWS MAP N.T.S. 7• CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. Benchmark: Car. LEGEND: O Catch Basin �--gg—1 PROPOSED CONTOUR �a O Elev. 54.99' tity^ s9 PROPOSED SPOT GRADE 9Q es — 40 - EXISTING CONTOUR .� �,4-) X 30.23 EXISTING SPOT GRADE � oc Old Post Road TEST PIT o`^oss C. Basin 9°' x54:98_s�° 55 12" Maple ® EXISTING WATER SERVICE i -��� . 104� (j`- 15" Maple , 54.8� SS gB 4a 24" OaIZ x 5h Row X --- �( WORK LIMIT LINE / I �� 5 `� ' Arborvit. -5v 56.33 't cy�''r• 14 56 a r S6 91,56 ��."•L� §G: 6.33 56:61 ' 49 Ur 56. u� 10/. 55: —� 56.69 I,ot Area 56.52 � 07121 t sf o AMY L. ;g 12.83' 101 ii cb9� c i VON ONE a hrO 16' 56.O \56.99 0 Paled ti, g� Drive ' t3 No. 1068 o ti \ 56 5s s71 O TH-1 h`O' co S c4i _5_6.95 Benchmark: Car. ^' d s, :No 69 Conc. Bulkhead at 6 STER CAD TH-2 o^ ^ Base. Exist. Dwell. '4 `4 57 _ 14 Elev. 57.5' a O Top Fndn. �.:.. _ 2 r� xi 6 Elev. 57.5' Reroute Cc Cellar -<P o Plumbing EL._ .8 ._ Ul -�, S �� (Crawlspace EL. 55.5 s� as c0 (� Floor Elev. 55.1) s Z3 °' - 23 NOTE: This plan is to be used for septic F Shed system purposes only and is not to be O S� Ve x 56.45 t x"57.12 S)t used for any other purpose. N \ ' � - _ 57 a- o Picket Fence h dka e, C_ 58= 5) 113.00 e8 69s 20 '99 156 OLD STAGE ROAD 48" Diam. Tulip Tree 19.1 o CEN TER VI LLE, MA Barn on Grade associates PREPARED SEP'n SYSTEM DESIGNS FOR: R.B.OU r Co., Inc. A 320 Cotuit Road Septic System and Sandwich, MA 02563 Site Plan Eileen F. Powers (0) 508.833.0041 NOTE: Pump and backfill (C) 508.274.0074 156 Old Stage Road failed cesspools. Sunroying br. Centerville, MA 02632 P It AH Ojala Surveying Arne H. Ojala,P.L.S. 211 Maple stet DATE REVISED SCALE SHEET N0. West - MA 5oa 3620 026 9346a 08/17/18 1» = 20' 1 of 2 fi �I 1r it Provide Riser over D-box , NOTE: All components to be marked with NOTE: To prevent breakout, final T.O.F. (Full C.C. Cellar/Crawl) to within 6" of final grade ; magnetic tape or similar prior to final cover. grade of EL. 52.6 to be carried EL. 57.5 (Cover to be watertight) T . out a minimum 15' beyond edge F.G. EL: 56.75-57.25f EL. 56.0 F.G. EL: 56.5 Maintain Min. 2% slope over leach facility to of leach facility.(Existing grade Existin revent ondin ,,,F.G. EL: 56.0-56.5 meets breakout. (Exist. invert � ) EL. 55.85) Install risers w/covers over inlet and Min. 2" of 1/8" - 3/4" Washed Stone or In ection Port within 6" to grade outlet to L=50' (Access Covers min.. 20" dia" of final mra er Code Geotextile Fabric Prop. invert ° 4" SCH 40 P , p ) L=10 3/4 - 1 1/2 Double Washed Stone Top of Chamber EL. 53.5 EL. 55.5 4" SCH 40 PVC L=15 Top of Peastone or Geotextile Fabric EL. 52.6 77 CAS=3% 2%�A �, 4 SCH 40 PVC .. ia• ®S=10% 1 ®® 66 6 CADS=1.3% 1.OWIN ®®age®® 24' Eff. Depth Crawl Space Floor EL. 53.75 aaaaa®® P EL 52.5 aaaaaeB TRottnm FI 50.3 EL. 55.1 EL 54.0 Install Gas Baffle EL. 52.67 EL. 52.3 Use 3 - 500 Gallon Precast Chambers (Above Leach Facility PROPOSED DB-3 Breakout EL 52.6) H-20 DISTRIBUTION .BOX (H-10) with Double Washed Stone 7 4' (Install PVC Outlet Tee) Watertest for levelness 4' Ends, 4' Sides ' if more than one SEPTIC SYSTEM PROFILE (33 x ,2.83 x 2 > PROPOSED 1500 GALLON EL. 42.9 H-10 SEPTIC TANK outlet N.T.S. Bottom of TH-1 ADDITIONAL NOTES SOIL LOG DESIGN CRITERIA SOIL EVALUATOR: AMY L. VON HONE, S.E. #2517 1. Contractor to confirm soil suitability prior to installation. Contact BOH and Number of Bedrooms:Existing 4 Bedrooms INSPECTOR: DONALD DESMARAIS, R.S., BOH Design Sanitarian in the event of varying soils from original soil test. DATE: JULY 31, 2018 11:00 AM Soil Type: Class I PERMIT: #15742 2. Pump and backfill Failed Cesspools. Any contaminated materials within 5' Percolation Rate: <2 min/Inch PERCOLATION RATE:<2 MIN/INCH IN C1 of proposed Leach Facility to be removed• Replace with clean fill per Title 5 specifications. Daily Flow: 110 G.P.D./Bedrm x 4-440 G.P.D. TH - 1 TH - 2 ' Design Flow: 440 G.P.D. (Min. Required) 3. Sewer line to be sleeved at any waterline I crossings and within 10' of EL 56.56 EL 56.2 waterline, as needed, per Water Department requirements. Sleeve to be Garbage Grinder: Not Allowed A A placed 10' on either side of waterline and ends to be cemented. Sandy Loam Sandy Loam i Leaching Area (440)/0.74 = 594.59 S.F. 10YR4/2 10YR4/2 „ Required: 10" 55.73 10" 55.37 4• Septic Tank and Distribution Box to be placed on 6 crushed stone or 8, a compacted, level base. Septic Tank Required: 440 G.P.D. x 200% = 880 G.P.D Loamy Sand Loamy Sand Minimum 1000 Gallon (Existing) 10YR7/8 10YR7/8 SEPTIC TIES Use 3 - 500 Gallon Precast Chambers H-10 with 30" 54.06 24" 54.2 Double Washed Stone: 33' x 12.83' x 2' Ct C1 Coarse Sand Coarse Sand , , 2.5Y6/6 Peerc 2.5Y6/6 Sidewall Area: 2(33 + 12.83 )2= 183.32 S.F. 46" Bottom 00 Bottom Area: 33' x 12.83'= 423.39 S.F. 12 83' Total Area: 606.71 S.F. 610, 4 Desic n Flow Provided: 0.74(606.71 S.F.)= 448.96 G.P.D. 156 OLD STAGE ROAD 3 ' ' Base_ CEN TER VI LLE, MA Exist. Dwell. '0 0 Top Fndn. aSSOCIateS PREPARED cc Cellar;._. FOR: 122" 46.39 160" 42.9 Elev, 57.5' [SEPTIC SYSTEM DEsicws R•B.0 U r Co., Inc. 4 (Crawlspace 320 Cotuit Road Septic System and No Groundwater Observed No Groundwater Observed Floor Elev. 55.1 P y Sandwich, MA 02563 (0) 508.833.0041 Site Plan Eileen F. Powers <9" @ 7: 30 min. PERC RATE: <2 MIN/INCH C1 Horizon Y (C) 508.274.0074 156 Old Stage Road I, Amy L. von Hone, S.E., hereby certify that I am currently approved by 9' s"^e'n9 b" Centerville, MA 02632 the DEP pursuant to 310 CMR 15.017 to conduct soil evaluations and AHOjala Surveying that the above analysis has been performed by me consistent with the i} ArneH Oyala,P.L.S. requirements of 310 CMR 15.017. 1 further certify that I have " 211 MaPie Street DATE REVISED SCALE SHEET NO. West Barnstable, MA L668 „successfully passed the Soil Evaluators Exam on November, 1995. 5M-362-os34 08/17/18 1 = 20, 2 Of 2