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HomeMy WebLinkAbout0650 OLD STAGE ROAD - Health 650 OLD STAGE ROAD CENTERVILLE A= 191 -015 SMEAD KEEPING YOU ORGANIZED No. 12534 2-153L0R SUSTAINABLE MIN RECYCLED IN�IT�VEI CONTENT 10% CertifisdFiberSourcing POST-CONSUMER® www.sliproBrem.orp SFl-012W ' MADE IN USA GET ORGANIZED AT SMEAD.COM i i TOWN OF BARNSTABLE LOCATION &50 pLp SAgec, SEWAGE# 2019 - L4t4 I VILLAGE C.cn4c r u;) I L ASSESSOR'S MAP&PARCEL 19) IS INSTALLER'S NAME&PHONE NO. B!S EXCsxL;a_-110 s1 t4nf `-btZ3 SEPTIC TANK CAPACITY /Soo qo- LEACHING FACILITY: (type) .SWga l FJ ZO Ld'c�3�(size) 13 X 33 x: 2 NO.OF BEDROOMS L4 ? OWNER AO(1ty L Fi 1 i ayI$ c), PERMIT DATE: 11-Z1- 19 COMPLIANCE DATE: o Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leachin acility Feet FURNISHED BY ffg vld Al-� 3-5 (o D AZ 2-71 $,. 5 sz. 32 REAR A3. L49 3 3' y3S SS,s„ O 0 - Ay', i,,S„ d3�1 3 • 0 No. 0 1 I�I I q Fee ` V v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftPhLation for VspoBaf 6pstrut Construction Permit Application for a Permit to Construct( ) Repair(,/) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components • Location Address or Lot No. W!0 O 1 d S�o.9i, Rd. Owner's Name,Address,and Tel.No. F i{;o.v 1•i- Assessor's Map/Parcel 19i (oS0 Old Srk•o, e, Ack. CArvarv,liQ, Installer's Name,Address,and Tel.No. Q>$1b 9Wccovoj6on Designer's Name,Address,and Tel.No. GI nha.olrt ruujU ro 31� Fiou�c 1 0 Sw�dwi 0', Ni a Soft 411.O C3 PA. (�>ox 331 V-o 4,0, /Ao�. OZlogS 1'14-CON-1146 Type of Building: Dwelling No.of Bedrooms Lot Size .57. ht.f 6 5+" sq.ft. Garbage Grinder(NO) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 454 gpd Plan Date I I I 19 11 g Number of sheets 2 Revision Date Title Size of Septic Tank 1500 00ons Type of S.A.S.�3� $00 A6kkOn Chomberd Description of Soil_SER., pkonS Nature of Repairs or Alterations(Answer when applicable)= {-o,l\ nW SAS and Ji-box Conna V no +C, exis\-:c,o, ISoo %%kloh seek,(, _-ank. 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 ,=j . Date Application Disapproved by Date for the following reasons Permit No. 01015 a y I Date Issued � r sc ^ No. t} ( + 1,l Ll I Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 2pplication for Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair(�) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. (o S O 6 I d S4 c,c,� R cs. Owner's Name,Address,and Tel.No. Assessor's Ma /Parcel C e me r v 11 e o p � �S 01c1 S-4-nC, [act. Cerrle ry.\It, Installer's Name,Address,and Tel.No. �� r av a+,o n Designer's Name,Address,and Tel.No. F 1 c.h a c 4,�, CL­jo o 5,09•`ill C)LTS P.O. Soy 331 Ha,w,cF l�o . OZ+��15 "ICI 1r1�1 116(0 T)rpe of Building: Dwelling No.of Bedrdoms Lot Size ..Sit r v,,ti_ sq.ft. Garbage Grinder(NO) •., Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) y 4 o gpd Design flow provided H S H gpd Plan Date 11 1 q f 9 Number of sheets �_ Revision Date Title t4 `sSize of Septic Tank 0 15 Type of S.A.S. A r Description of Soil cz e Nature of Repairs or Alterations(Answer when applicable) J r 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_ �I _/cj ,y I . Application Disapproved by Date for the following reasons �. -Permit No. _ of ' t_� ( Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) .z 133:•rt'r. Abandoned( by at to S U ow ct S4 n e r 4 e r u,\t a has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. 2 Oil`4 1-11 dated I 1 t ' /7 Installer �t,Y Designer 1r,\,o;t,. r,,r rna 0�,,i #bedrooms y Approved design flo gpd The issuance of this pe it s all not be construed as a guarantee that the system wil,fund as desi ed. Date E Z Inspector No. a o,9 LI L� Fee l y'(J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction permit Permission is hereby granted to Construct( ),_\ Repair(t/) Upgrade( ) Abandon( ) System located at {g p n i and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her du tyto 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. C Date (— I Approved by r Town of Barnstable HE Tp� Regulatory Services ti�P� ti� Thomas.F. Geiler, Director STABLE, Public Health Division rt ,y MASS. 03.�� Thomas McKean, Director rb -200 Main Street, Hyannis, MA 02601 "• r'• (Office: 508-562-4644 Fax: S0S-790-63304�i Date: M-2-h1 Sewage.Permit# 2019- 4t4 1 Assessor's Map/Parcel J 1• IS P : Installer & Designer Certification Form Designer: 719, Erw;ror�ns�a0 Installer: Bti.g ExcAtJc6.4 io1� .address: X 331 Address: 1y�-Tea�e�rU Lr.� �QC'u.91C� rOCtS"��IG nii, was issued a permit to install a. (date) (installer) septic system at p pl,pSa�g� (2�. based on a design drawn by (address) dated 01- 19- 19 (desrg`ij`err 1 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. Stripout (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' lateraf 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. Stripout (if required) was inspected and the soils were found satisfactory. Of ')AV) 1 D 3 Installer's S1JR g. to e-) �HER �. No 1211 (Designer's Signaturl (Affix Desig Zp 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. i gAoffice fomisWesignercertiflcauon form.doc ��slti Town of Barnstable Inspectional Services Department "`" i639' Public Health Division ♦� A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4988 0947 October 15, 2019 FILIAULT, BONNIE P 650 OLD STAGE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 650 Old Stage Road, Centerville, MA was inspected on 09/18/2019 by Chad Hathaway, 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: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360—20h). You are ordered to repair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S., CH0 Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\650 Old Stage Road Centerville.doc Town of Barnstable q . • BAW 9TABLE, Inspectional Services Department TEp MA'f A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 ❑ Structurally unsound septic tank or SAS 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 o a driveway due to H-10 components, etc) eaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts `/ 06 Title 5 Official Inspection Form 1 [r, Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address `c Filiault Owner Owner's Name " information is ✓ r required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information (-�'�-- on the computer, use only the tab Chad hathaway key to move your Name of Inspector cursor-do not HPS use the return Company Name key. P.O.Box 151 Company Address Forestdale Ma 02644 City/Town State Zip Code 774 274 2581 12866 Telephone Number License Number B. Certification 1 certify that: 1 am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority I 4. ® Fails Zr_� 9/18/19 Inspector's Sign at Date The system inspector shall sub i a copy of t s inspection report to the Approving Authority(Board of Health or DEP)within 30 d s of completi this inspection. If the system has a design flow of 10,000 gpd or greater, the in pector and system owner shall submit the report to the appropriate regional office of the DEP. Th form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: 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. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts l= Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) 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: This inspection is not a guaranteeand applies no warrantyof the described septic components in this report including but not limited to piping structual intergrity of components and life exspectancy of leaching and described components. This inspection is to describe conditions witnessed at time of inspection only. Regular tank maintenance and water conservation can prolong life of septic systems Information on care and do's and don't's can be found at town health dept or mass.gov 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c`X, Commonwealth of Massachusetts �n ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Stage-Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ® Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) 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. a. 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ 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 b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: *"This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No E ❑ 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 . page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply 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 2000 gpd- 10,000 gpd. ❑ ® 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. 5) 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 CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 c .` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: 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? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? ❑ ® Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 T Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): no deesign Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: Number of current residents: 1 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes E -No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form iSubsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Stage_Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: 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 below): 3. Pumping Records: Source of information: unknown Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons ,How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. 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: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2'feet -Material of construction: ®cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line. 20+ see asbuilt feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 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? Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 cam, Commonwealth of Massachusetts !n ,4 Title 5 Official Inspection Form w, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. CityrFown State Zip Code Date of Inspection D. System Information'(cont.) 8. Tight or Holding Tank(cont.) 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 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form ,. w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage_Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 1 ❑ 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: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 c Commonwealth of Massachusetts �9 Title 5 Official Inspection Form Subsurface-Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): leaching pit 6'x6' precast. full to pipe level 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration 2 Depth—top of liquid to inlet invert 4" Depth of solids layer 18"sludge Depth of scum layer 6" Dimensions of cesspool 6'x6' 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.): both cesspools are full to outlet pipes. block setttlement and seperation on cesspool cone present t5insp.doc•rev.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �A = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments L, 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is Centerville Ma 9/18/19 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 c Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System, Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 0 1� Z)A- �-o Scr tt I 1 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 Commonwealth of Massachusetts �a Title 5 Official Inspection Form l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 6*; 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: 24 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: town GIS mapping You must describe how you established the high ground water elevation: lot el. 56' low in area 32' bottom of SAS 9' grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Ip Title 5 Official Inspection Form �' le Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 650 Old Stage Rd Property Address Filiault Owner Owner's Name information is required for every Centerville Ma 9/18/19 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6(Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of Barnstable Inspectional Services Department 03q. Public Health Division s6 �� , A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4988 0947 October 15, 2019 FILIAULT; BONNIE P__ 650 OLD STAGE ROAD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 650 Old Stage Road, Centerville, MA was inspected on 09/18/2019 by Chad Hathaway, 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: • Leaching facility with standing liquid level at or above the invert pipe (per Town Code 360—20h). You are ordered to repair or replace the septic system within two (2)years from the.date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE OARD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\650 Old Stage Road Centerville.doc y .. • . COMPLETE • ON DELIVERY a, Complete'Iterr1� ',2,and 3. A. Signature I ■ Print your na' d address on the reverse X ❑Agent 4i I so that we can return the card to you. ❑Addressee I; I ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery i or on the front if space permits. - -Tess different from item 11 ❑Yes i - lelivery address below: ❑No T FILIAULT, BONNIE P 650 OLD STAGE ROAD i CENTERVILLE, MA 02632 I I II I'III'I I II I'I I IIIIIII IIIII'I II I I I IF111 3 SinSignature Sig atur ❑Priority Mail 6 presse � II ❑Adult Signature ❑Registered MaiITM ult Signature Restricted Delivery ,❑��RRpegistered Mall Restricted 9590 9402 5357 9189 1903 57 certified Mall Restricted Delivery Neltu Receipt to / I ❑Collect on Delivery `Merchandise 2. Article_Numhar/Trapcf_s. _ —Delivery Restricted Delivery ❑Signature ConfirmationTM "d"7 015 1,730 0001 4988 0947 ill ❑Signature Confirmation II Restricted Delivery Restricted Delivery 1 (over$500) PS Form 3811,July 2015 PSN 7530-02-000-9053 I Domestic Return Receipt I r Lidto 4-ra . 0 9.-G-6t'E9a-ZZC0 0.0Z00+sT09Z0 :3V 361 n 6T.t `ZYTT0e1 ,30 S TO ;aaxIM I I U_ d(-)a EKV1S (110 099 d 91NNO9 'rinvi-l=i 9 3�11?N t 33111 f�1�1 6 L OZ 9 L 100 SSb9££0000 z+160 996h T000 0U.T 5r[OZ y 08'900 $ ZOmt, ZO __ r � L 09Z0 dIZ i- � Z Wd 109Z0 W`stuu�iH ` ,mWaj�y laaS �l 11 UT*W V tlN OOZ •3'10tliSNNtl9 ��+.... uoTstAiQ glteag otlgnd o a� S3MO8 A3Nlld<<30VMd S(1 ti''1ti,1'.: .. {' _ _ � a[geisuaeg,�o un4Lo,L i �t t.�C�:i�Et:::it:y.tyi.�, .i�lltt•'!'�y'!`t"�'!�l�i��.'!il°'�.�� y 4 �. COVERS BE WATERTIGHT AND TOP OF FOUNDATION ROUGHTOTO WITHIN 6"OF FINAL GRADE SEPTIC SYSTEM PROFILE Flahe Environmental Services EL. 62.0 EL. 60.0 (not to scale) INSP. PORT W I 3" OF GRADE CLEAN SAND P.O. Box 331 151111111 2"of k to " DOUBLE WASHED PEAS ONE-OR GEOTEXTILE EL. 60.0, Harwich MA 02645 4" CAST IRON or EQUIVALENT FILTER FABRIC ~ 774.994. 1166 MIN. PITCH 1/4 PER FOOT 4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE. ' • FLOW LINE (fl{st2'tobe/evel) VENT IF REQUIRED 32' 1.6% 5 •'• �i► 4. I 14" 7ec-�o EL.57.75' \EL 57.5' 0'°0°'0°'0°0°° o 0 0 .'®® • EL56.83' o00 000 o 0 0 0 0 0 0 .� 10'M N (2 5�k L. 0' °o° 0000000000000 2.0' GAS BAFFLE (H--200-BOX) EL 56.8 °000°o°o°o oo°o°o �.• ® :a. 000000000° 000°00 . ed' • Q EL 54.8' 6"CRUSHED STONE OR SOIL ABSORPTION SYSTEM MECHANICALLY COMPACTED (3) 500 GALLON H-20 CHAMBERS (DATUM: ASSUMED) WITH 4'STONE AROUND IN A 5.3' " to 14" DOUBLE WASHED STONE• 1500 GALLON SEPTIC TANK _ _ 12.83'W X 33.5`L X 2'D CONFIGURATION BOTTOM OF TEST HOLE EL. 49.5' EL. 49.5' USGS ADJUSTMENT: N/A LOCATIONNAP 10.9 GROUNDWATER ELEV: N/A LOCUS BENCHMARK: N TY'1 0_ CRNR OF SH 60 a EL, 62.0' ,1 68, O 62 20 ;t`:a o (: O LOT 14 42. TH- ''� ��s��J 11.0 4 0.52 ACRESt O MAP 191 ` O Rt.28 — PLOT 15 EX�SBRING 12.0 CP —� DWELLING PROP. NTS 1500 GST o0 66 (H OF f4gSs4 DECK DAV' P,S G F Eq J ul GARAGE m t o X gNITAR�a Q q 0 DRIVEWAY i DATE.•1111912019 REVISED: � LEGEND 62 64 66 60 e 6rs e GAS LINE SITE AND SEWAGE PLAN FOR iI / -Uf � W� WATER LINE B & B EXCAVATZON, INC. , �' E E E E—E— EXIST. ELECTRIC ' 140,92 BONNIE P. FZLZAULT 99 EXIST, CONTOURS ' f 650 OLD STAGE ROAD ————— 99 PROP. CONTOURS CENTERVZLLE, MA a o o EXIST. FENCE i SCALE: 1" - 3 O' REF•LCP 32373-D PAGE 1 OF2 , } .......................................................................................................................................................................................................................................................................................................................................................................................... ...................................................................................................................................................................................................................................................................................................................... ........................................................................................... GENERAL NOTES DESIGN CAL COLA TIONS Flaherty Environmental Services S YS TEM DETAIL P. 0. Box 331 1. ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645 RATED UNLESS OTHERWISE SPECIFIED. NUMBER OFACTUAL BEDROOMS 4 774.994.1166 DISTRIBUTION BOX(ES)AND ANY COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO VEHICULAR TRAFFIC TO BE H-20 RATED. 2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW ALLOW FOR THE USE OFA GARBAGE (110 GAUBRIVA YX 4 BR) 440 GALADA Y; 33.5' GRINDER. REQUIRED SEPTIC TANK CAPACITY 880 GAL. 3. MUNICIPAL WATER IS AVAILABLE. 4. ALL CONSTRUCTION To CONFORM WITH SIZE OF SEPTIC TANK 1500 GAL. (PROPOSED) AL, STATE AND FEDERAL SOIL CLASSIFICATION 310 CMR 15.000 AND ALL OTHER APPLICABLE LOC CODES AND REGULATIONS, DESIGN PERCOLATION P.4 TE <2 MIN./INCH12.83' 5. INSTALLER/CONTRACTOR TO REVIEW& VERIFY ALL ELEVATIONS AND DETAILS EFFLUENT LOADING RATE a 74 GAL.IDA YIF T2 AND REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR . . . . . . . LEACHING AREA ASSUME ALL RESPONSIBILITY. (2)x(33.5'+ 12.83)(2) = 185SF 6. INSTALLER/CONTRACTOR IS 33.5'x 12.83' =429 SF RESPONSIBLE FOR MAINTAINING SAFE 614SFxa74 =454 GPD 100% RESERVE WORK AREA, VERIFYING ALL U77LrTIES AND NOTIFYING "DIG SAFE" USE(3)500 GALLON H-20 CHAMBERS WITH 4'STONE (1-888-344-7233) 72 HOURS PRIOR TO AS DIAGRAMMED INA 33.51 X 12.83WX2.0'D CONFIGURATION CONSTRUCTION. 7. ANY CHANGES TO OR DEVIATIONS FROM THIS PLAN MUST BE APPROVED IN RESERVE LEACHING CAPACITY 454 GPD WRITING BY FLAHERTY ENVIRONMENTAL SERVICES AND LOCAL BOARD OF HEALTH. 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS) UNLESS SHOWN PER PLAN 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION FILLED WITH CLEAN SAND OR REMOVED TEST HOLE#1 TPT#19-203 TESTHOLE#2 TPT#19-203 AND REPLACED WITH CLEAN SAND. Evaluator David D.Flahe*Jr.,RS,REHS Evaluator. David D.Rohe*Jr.,RS,REHS 10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755 RD DOH Witness: David Stanton,RS BOHess., David Stanton,RS WITH WATERTIGHT ACCESS PORTS Date. November 15,2019 Date. November 15,2019 WITHIN 6"OF FINISH GRADE. 11.ALL SEPTIC TANKS, DISTRIBUTION TH-I ELEV.60.0' TH-2 ELEV 60.0' BOXES AND PIPING TO BE INSTALLED WATER77GHT, 0.-9. A LS I0YR212 0%9" A LS I0YR212 12 NO KNOWN WETLANDS OR WELLS WITHIN 150 FEET OF PROPOSED 9*-26' 8 LS 10YR" 9* 26' B LS I0YR516 LEACHING. 13.THIS IS NOT A CER77FIED PLOT PLAN P77 per-(45-) AND UNDER NO CIRCUMSTANCES IS THIS PLAN TO BE USED FOR ZONING OR W 7 cet that on November 12,2W2,l have passed the examinaffon and the Dwartment of BUILDING PURPOSES. Environmental Protection and that the above analysis 14.LOT IS SHOWN AS ASSESSOR'S MAP 191 has be-perforwed by me consistent With the SITE AND SEWAGE PLAN FOR required wning expertise,and experience described 8& 8 EXCA VA TZON, INC./ LOT 15. 261-126' C MCS 2.5Y&46 in 3 10 CMR 15.018(2). — 26'-120' C MCS 2.5Y616 BONNIE P. FZLZA UL T 15.LOCUS PROPERTY IS NOT LOCATED WITHIN AN AQUIFER PROTECTION 650 OLD STAGE ROAD CENTERVZLLE, MA DISTRICT(ZONE II). G.W.ELEV.NIA G.W.ELEV.NIA BOTTOM TH-fELEV. 49.5' BOTTOM TH-2ELEV. 50.0'1 PAGE20F2 DATE:1111912019 ........................................................................................................................................................................................................................................................................................................................................... ............................................................. ......................................... ..............----------................................................................. ..............................................................................................................................................................................................................................................