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HomeMy WebLinkAbout0029 PADLOCK LANE - Health 29 Padlock Lane Centerville %A= 173-036 NJ � UPC 12534 ' No.21-.53LOR ���bb?GONSJ�wo- HASTINGS,MN TOWN OF BARNSTABLE LOCATION 29 R.A- SEWAGE# 20 Z 1 ' O L G VILLAGE Cc(\Ac r u.I c ASSESSOR'S MAP&PARCEL 1713 - 36 INSTALLER'S NAME&PHONE NO. EXcQL)(x4 i Ors q n n- 0(,53 SEPTIC TANK CAPACITY /4600 qa.1 LEACHING FACILITY:(type) 500 qg&l LIc (Z) (size) 13 A Z S x 7- NO.OF BEDROOMS 3 OWNER kp rcr\ PERMIT DATE: S-S. Z I COMPLIANCE DATE: 3 a 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 a►^ it, *2�padlock AV Is ' Zp A A3.3$'s 83- Z � � Q REAR Ay- 43 ' 3 , u . 3 L.00_QT10N 5E_WQC E PERMIT MO. Lor Nl E—�—,N D D R E S S - T - 5U t L-D E_R-5 D QTE PE-R_M17-1_SSUED'—�'��-Z ------�- ---- --- _— I 44 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE,_MASSACHUSETTS Yes Rpplifation for Misposal *pstrm Cunstrurtiun VPrmit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System X Individual Components Location Address or Lot No.Zq 1P %wc &0,A Owner's Name,Address,and Tel.No. Kopran W 4611io O Assessor'sMap/Parcel %-43 1 q 90400r- U. Installer's Name,Address,and Tel.No.VJ3 b SY.COwGhon Designer's Name,Address,and Tel.No.F,a�1¢t� cvwo- 3�y (,oc�C. GO San& ,0, 4-41 .06S5 PO box 3-Y NatW,c,\, �A 02e4< Type of Building: Dwelling No.of Bedrooms 3 Lot Size 0.3 S AC45 /sq.ft. Garbage Grinder(\40) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3'SO gpd Design flow provided gpd Plan Date 3( 7.1 21 Number of sheets 2 Revision Date Title Size of Septic Tank 000 10n Type of S.A.S. aaNko r L 1 S Description of Soil So2 PIOA3 Nature of Repairs or Alterations(Answer when applicable) \&aatt (2.,) ,�0 0 A0110 n Lies o rin c} (\( kp c3 OOO nlo� t' '-1�— 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 A- Application Approved by Date S Z Application Disapproved by Date for the following reasons Permit No. 7�( �®�Q Date Issued 3 z j DD No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: ✓ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes *pYication for ]Disposal Opstem Construction permit Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System Individual Components p.; Location Address or Lot No. rici Owner's Name,Address,and Tel.No. �Cac�n tii @h1 in cj Assessor'sMap/Parcel 1-4S 7-cj 9C\6koc\�, Installer's Name,Address,and Tel.No. r C"i CAwn Designer's Name,Address,and Tel.No.��c��1 k`' ',(\u G - ; ` t'�A(ko.C+5 J IC). 0(y,ot/ Type of Building: Dwelling No.of Bedrooms Lot Size Q S AC(Qi tsq.ft. Garbage Grinder(Q(. Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) S"J O gpd Design flow provided `x gpd Plan Date 2� 2( 2.e Number of sheets Revision Date - 0 Title {{ Size of Septic Tank! �000 rt-oM on Type of S.A.S. (Z � ` tan rV W, L ('S ;�^Descriptiowof Soil So e Nature of Repairs or Alterations(Answer when applicable) `���e,�( (� � SQ 6 ('!Gatti , L,(L S -'. QV",k\0\ WOG a(I-W" `eft !Date last inspected: _ �r r', 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 !�l. C' C: r C�/ �.. Date ,R_ • �, ! Application Approved by i�.�� ' \._1 Date Application Disapproved by -�- Date 1 for the following reasons r w t Permit No. � ' f G �P Date Issued 3> 5-1 -t f ---------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired O Upgraded( ) Abandoned( )by at Z q PoAkqr_L has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. lrti '0 dated Installer QA? (� 12X C C11jC4 r o� (Clc Designer #bedrooms Approved design flow 31 D gpd The issuance of this permit shall not be construed as a guarantee that the system will`funetion as designed. (' Date A � � Inspector �� )I / M r No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction i3ermit Permission is hereby granted to Construct( ) Repair,( Upgrade( ) Abandon( ) System located at Po,dt o-'c 12,k . 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 b171, leted within three years of the date of this permit Date 3 Approved by / . __, Town of Barnstable Inspectional Services Public Health Division nnt;rrsrast.s. M^M Thomas McKean,Director 039.cam° 200 Main Street,Hyannis,MA 02601 Office: 508-8624644 Fax: 508-790-6304 Installer& Designer Certification Form Date: a-19.21 Sewage Permit# 2o21. OLG Assessor's Map\Parcel MZ-3L Designer: la�lncrlK Ca�:ora,Ntcni� Installer: � � Em3auoA'io,n Address: 'Po. f30x 331 Address: 14-TcoLJ5crr" L►rO �TyJ�¢�. Foe-es'I�lc�lL On 3-S-21 B Q CxeotOOLA"a was issued a permit to install a (date) (installer) septic system at 29 Vad.locll QJ_ based on a design drawn by (address) 'Dolie T\",_-r AsA dated 3-2.71 (designer) X _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 i coTc with the to rms of the I\A approval letters (if applicable) DAVID � n nl D. CQG�� FiA-,ERTY,IR. C, (I tailer's Si u e) No. 1211 7,,14 esigner's Signatur (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. WoMdeptsNBEALTMSEWER connectSEPTIC01esigner Certification Form Rev 8&14-13.DOC I Commonwealth of Massachusetts W Title 5 Official Inspection Form p � - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Padlock Lane N 4 Property Address r•.� William and Eleni Evangelakos Owner Owner's NameI „ information is irrB 12/18/2014 C��-��r V� {I� MA 02146 �, required for every � page. City/Town State Zip Code } Date of Inspection 03(� 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. General Information I on the computer, p� use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David B. Mason r� Company Name 4 Glacier Path Company Address. East Sandwich MA 02537 City/Town State Zip Code 508-367-1617 S1287 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 15.600). The system: j ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 12/18/2014 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This;report only describes conditions at the time of inspection and under the conditions of use ,a k6t time.This inspection does not address how the system will perform in the future under the same or-different conditions of use. t5ins•3/13 S Title 5 Ofjetiom:Subsurface Sewage Di posal System Pagel 17 tea rw Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 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: The observations noted in this report represent the condition of the system only on this date of inspection and the information contained herein does not guarantee the continued operation of the system. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. 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): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Padlock Lane M Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ 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. 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 '/2 day flow l5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 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 tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system 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. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. CityFrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health , ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ — Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gP ))� Detail: 201; 86,000 gallons and 2013; 77,000 gallons. Sump pump? ❑ Yes ® No Last date of occupancy: UnknownDate 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: See Above l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 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: Board of Health Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1974 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 2feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2 inchesfeet 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: 1000 Typical Sludge depth: 2 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments C �M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 47 1„ Scum thickness I Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. CitylTown 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, Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3l13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ;M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): No dbox present 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. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3113 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 ,M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ 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.).- Leaching pit is 24 inches below grade with risers to within 12 inches of grade. Effluent is 3' below the inlet invert of the leaching pit with no staining above. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer — Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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.): t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c, °M 29 Padlock ad ock Lane ae Property.Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town 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 where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town 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: 18 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: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 29 Padlock Lane Property Address William and Eleni Evangelakos Owner Owner's Name information is required for every Brookline MA 02146 12/18/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Assessing As-Built Cards Page 1 of 2 LOCATION 5EWW:,E PERMIT U VILLLL PAGE , IN�S^ TALLER 5 W&DIME ADDRESS BUILDER 5_ Q LAME ADDRESS DATE .PERMIT 155UED :---/L�- 7 �? s DATE COMPLI&MCE IS5UEO : 5 rp t http://town.bamstable.ma.us/Assessing/HMdisplay.asp?mappar=173036&seq=1 12/18/2014 INME Town of Barnstable Inspectional Services Department �aA M M`� ' Public Health Division 9•i63 ,0�' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8333 February 8, 2021 WATT, KARON G 15565 SW 150TH STREET ROSE HILL, KS 67133 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 29 Padlock Lane, Centerville, MA was inspected on 01/18/2021 by Scan M. Jones, 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 360-20 h). 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 BOARD OF HEALTH kean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\29 Padlock Lane Centerville.doc r THE tp� Town of Barnstable mRNSTAOM Inspectional Services Department prfDMA�p Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A. McKean,CI10 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 is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located 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) Veaching 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 /7-3 _ a3( Commonwealth of Massachusetts �4 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information on the computer, Brett Hickey use only the tab y key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address Sandwich Ma 02563 City/Town State Zip Code a®da; (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I 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 4. Fails Brett HickeyDigitally signed by Brett Hickey Data:2021.01.18 14:20:37-05'00' 1-18-2021 Inspector'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 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. t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts - -- Title 5 Official Inspection Form - � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r/ 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1=18-2021 required for every 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: 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 forges", "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): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 2 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments c 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town 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: t51nsp.do6•rev.7/2 612 0 1 8 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 29 Padlock Lane Property Address Karen Wehling Owner Owners Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) Cesspool or privy is within 50 feet of a surface water ❑ P P Y e ❑ 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 ❑ El clogged of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ 0 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 tjp� Subsurface Sewage Disposal System Form -Not for Voluntary Assessments t 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.)' 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ o 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). 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. ❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El 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.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. E ❑ 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 El ❑ y t 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 t5lnsp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - ' 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town 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 ❑ El Pumping information was provided by the owner, occupant, or Board of Health ❑ 0 Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ O Have large volumes of water been introduced to the system recently or as part of this inspection? O ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ [E] Was the facility or dwelling inspected for signs of sewage back up? 0 ❑ Was the site inspected for signs of break out? El ❑ Were all system components,excluding the SAS, located on site? 0 ❑ 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: M. ❑ Existing information. For example,a plan at the Board of Health. ❑ El 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 c Commonwealth of Massachusetts --� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments l� 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: No design plans 3 Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): NA Description: j No design plans or permits on file with local Board Of Health Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes 91 No Does residence have a water treatment unit? ❑ Yes Q No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ❑ Yes No Water meter readings, if available(last 2 years usage(gpd)): See below Detail: 2020- 219,000gallons 2019- 211,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate t51nsp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 18 Commonwealth of Massachusetts — Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: NA 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: Owner- date of last pump is 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 �v- - Title 5 Official Inspection Form j' Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is required for every Centerville Ma 02632 1-18-2021 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 UA system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. El Other(describe): Tank and pit (no d-box) Approximate age of all components,date installed (if known)and source of information: 1978 per COC date on asbuilt Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ■❑40 PVC ❑other(explain): Town water Distance from private water supply well or suction line: 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 Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Y rY 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 1' Depth below grade: feet Material of construction: R 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 1 Dimensions: 000gallons Full over tees Sludge depth: to n Distance from top of sludge to bottom of outlet tee or baffle u n Scum thickness — r� n Distance from top of scum to top of outlet tee or baffle n n Distance from bottom of scum to bottom of outlet tee or baffle viewed 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.): The tank was in working order at the time of inspection. The tank is in need of pumping at this time and should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I Commonwealth of Massachusetts - : Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town Satet Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: NAfeet 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: NA Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5lnsp.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 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town 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): NA 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts -F Title 5 Official Inspection Form �~ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every 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.): NA * If pumps or alarms r n p p are of 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: FX-1 leaching pits number: (1 ) 6'x6' pit ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owners Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.)y c 11. Soil Absorption System (SAS)(cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in hydraulic failure at the time of inspection. Pit was full over inlet tee and was backed up into the septic tank. 12. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is required for every Centerville Ma 02632 1-18-2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5lnsp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4' 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town Satet 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 HotISE. B Porch Deck A, Garage C A1.gr B1.20" B7'2T C.2-22 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments j 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town 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: System in failurefeet 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: Not determined as system is in failure Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts = p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Padlock Lane Property Address Karen Wehling Owner Owner's Name information is Centerville Ma 02632 1-18-2021 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: 0■ A. Inspector Information: Complete all fields in this section. �■ B. Certification: Signed&Dated and 1, 2, 3,or 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 No............ Fmiz......./. d.............. THE COMMONWEALTH OF MASSACHUSETTS ,pq BOARD OF HEALTH 3 R�l � '� - l 73 ........oF .....i ...................... --........... .........._. G Applirattott -for Utipoiittt Workii Towitrurttott Vrrmit Application is hereby made for a Permit to Construct (.Wor Repair ( ) an Individual Sewage Disposal. System at: t (2 FAli —,evi c ce (0 C-0 r46--r— t/�i- ' Location-Address, or Lot No. �� �3!►✓1 � �_.i���t2c�as .�"�Z:, �'= �6' �f�JU!°°��1.._ 11_ �� 1 �1�4 .- -,�k1 A5 S W wn r Address ,� --- = t l ------J 4�----------------------/-------------------------- � Installer _���r� Address (c•�� UType of Building Size ----Sq. feet Dwelling.—No. of Bedrooms-----------3----------------------------Expansion Attic ( ) Garbage Grinder aOther—Type of Building ---------------------------- No. of persons__-_-_------_-___----_--_- Showers ( ) — Cafeteria ( ) a' Othez, fixtures ------------------------------- --- Design W g _,�...........:........gallons per person per day. Total daily flow -------------------------------------------..gallons. P4 Septic Tank—Liquid capacity_ ..gallons Length--_-___-__--_- Width................ Diameter----------...... Depth..-..--_------- xDisposal Trench—No_____________________ Width.........._..__.___ Total Length__________________.. Total leaching area_..._._...._________sq. ft. Seepage Pit No......../----------- Diameter-------------------- Depth below inlet--------------------- Total leacl -ng 'area------------------sq. it. Z Other Distribution box ( ) Dosing tank ( ) r000 G21G. I_r9G111*6" ��� /4/� 41C f _ _;- Percolation Test Results Performed by-------------------------------------------------- -------------------- Date---------------------------------------- a Test Pit No. 1----------------minutes per inch Depth of "Pest Pit-------------------- Depth to ground water_.-.---..--:--_._..-.._. 14 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water_..._..-___-_--.__--.__. 9 -------------------------------------------------------------------------------------------------------••---------------------------------------------------- 0 Description of Soil______________ __ _/ C:._._5....!1/! x W UNature of Repairs or Alterations—Answer when applicable-------------------------------------------------------------------------....._.----------- ---------------------------------------------------------------------------------------------------------------------- -----•--•----- .......••-•---•--•---•-----.---.---------••---•----------•------- Agreement: The undersigned agrees to install the aforedescribed .Individual Sewage Disposal System in accordance with the provisions of Article \I of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance haSe• issued b t oard of h It 1 Afic , , , / fR✓ . Signed_.. --.. �y ----- --• -----• - ------- ................................ v t Date Application Approved By...... L��'�-�T .. -- . '----------- - -------------------___ �-�7 Application Disapproved for the following ea ons:-_---------•-------•--••-----•-•----•-••------------------------------------------------------ate-------------- Date Permit No. Issued ..... ................................. Date � w ®-�^ �-i � �� ___._ �. ---- - - � -- _� �� U �� a c� �, � © �J =Y �� ' � � .. vm � �5�--� 8� '� -.� �, all FE'...!........................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .. ..... ._ . ....... -- .OF.............................................................. , VVIiraiinn -for Ditipmal Works Tonstrnrtinn Vamit Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: Location-Address o t Ivo. N -' „_owner Address Installer, Address ` UType of Building Size Lot....L_5 �•7 _4?-----Sq. feet �-, Dwelling—No. of Bedrooms------------ 3......................_.--.Expansion Attic ( ) Garbage Grinder pa, ? Other—Type of Building'__.-_................... No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' 't f Other fixtures- d.r', r� WDesign Flow..................%t0 _--_-__,_--___._gallons per person per day. Total daily flow------- .---._-._-_---.-.......gallons. R; Septic Tank—Liquid capacity(P--gallons Length................ Width__............. Diameter-.._...._._.-• Depth...._._._...... W x Disposal Trench—No- --------------- ---- Width-_-_._..-.--..--.-_- Total Length---------- Total leaching area........--._.___--_-sq. ft. (Seepage Pit Ni ........... Diameter.................... Depth below Inlet.................... Total leaching are rt......._..._.•---sq. ft. z -�.4Other Distribution box ( ) Dosing tank ( ) J 0®p (1q•�6, pep ork,r/}/)/,< / 41 aPercolation Test Results Performed bY------- ----- ------ ------------------------------------ -----•----•- Date....------------------------------------ ' Test Pit No. L---------------minutes per inch Depth'of Test Pit.................... Depth to ground water---------............... fZq Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.........___--..--_--_- +;_ Description of Soil1_?I,/C....:: -�1 x ---;- . W U Nature of Repairs or.Alterations—Answer'*lien applicable._.....................,..-.-_-..-.-..-_..--.....-_---..--._.--.__.-____----..._.-._._... ,•- ' - -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of ArticLq\I oLthe State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of'Compliance hassbi e issued by th boar health. Signed- A ----------------------- Application Approved B " r Date. PP PP Y ------------------- �� � ''j�,.. �+'� . Date E, Application Disapproved for the following reaso :... E� Date Permit No.------•-•----•---•-----•-------•-••------_____•-----. `'' Issued. ( /' Date "' THE COMMONWEALTH OF MASSACHUSETTS V BOARD F HEALTH .., .. . ..............0F.....:..: . G�'x, •' --.... ...................................... .1. IfQtati of Grrmplianrr THI IS TO CERTIFY at th ndivid' 1 ewa isposal System constructed ( or Repaired ( ) ++ t I taller has been installed in accordance with the provtstons of Article XI of The State Sanitary Code as escribed in the ,• applic�Lion for Disposal Works Construction Permit No--.-.-.-.-.Z_-'�-�.�::............ dated__- f.a.- -.' - + - • - 1 THE ESSUAN .E--OF THIS CERTIFICATE SHALL NOT BE CONSTRUEQ AS A GUARAN EE TH� THE SYSTEM WILL FUNCTION SATISFACTORY. DATE. . ...........................................:--------•••••••---------..- Inspector .._.(... r � ;^ THE COMMONWEALTH OF MASSACHUSETTS ��.. BOARD O HEALTH. `I"ZriLrt........O F........ 4�L .t.: No.� . ---- .. FEE-- -�---"='•"-'"� i ;4 mat Di5papal Morkii Qlnnitrnrii t Vrrmi: , Permission is'hereby granted.- .-. ----------. "-,to Constr or Rep ( ) Ind' tdual S ge Disposal&tem at Noy - �J1,�a-•--•----•••----•-••-•- ��✓/ Street as shown on' the application for Disposal Works Construction ermit o._ '.._ Dated.-6//2""7_ --_--__ 7��` it { �J I f Board of Heallt DATE-___:,/Qr-..- -•- , FORM 1255 HOBBS & WARREN. INC.. PUBLISHE 3 i t— �tT Town of Barnstable "4 Inspectional Services Department B"` MAS& Public Health Division 1639.y ASS. iOlFcr9" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 8333 February 8, 2021 -- -WAT-T, KARON G - — - 15565 SW 150TH STREET ROSE HILL, KS 67133 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 29 Padlock Lane, Centerville,MA was inspected on 0111812121 by Sean M. Jones, 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 360-20 h). 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 BOARD OF HEALTH 0ean, R.S., Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\29 Padlock Lane Centerville.doc of °j Town of Barnstable i t' U.S.POSTAGE>>PITNEY BOWES �Hs r P Public Health Division ROV-115ENCE R ¢ (/ -t:7tm'. RARNSTARLE,� 200 Main Street �FOMP+• Hyannis,MA02601. FEB 2021 Eg � tZIP c 02.4Vy601 �' OV�.�pO 00003.73143 F 2021 EB. O5. (� (��L�i 7015 1730 0001 4987 8333 � t ,/r z/.Z '- �. U 1 —F SVI IS ` 5 �_.,.. .a.,., ... .� ...ate... .. ..... ...,.... - 1 ----------------- i SEN COMPLETE, • • 1 I ,. _ 1 ■ Complete items 1,2,and 3. A. Signature ; ■ Print your name and address on the reverse X ❑Agent i - so that we can return the card to you. ❑Addressee B. Received by(Printed Name) C: Date of Delivery � ■ Attach this card to the back of the mailpiece, 1 or on the front if space permits. I 1. Article Addressed to: _ _ _D.Js_deliverv_address different from item 1? ❑Yes 1 delivery address below: ❑ No • i M WATT, KARON G 1 —— 565 SW 150TH STREET ROSE HILL, KS 67133 i I - I �dult ❑Priority Mail Express®Signature ❑Registered MaiITM dultSignatureRestricted Delivery ❑ egistered Mail Restricted) _ ertif ed Mail® /Delivery I j 9590 9402 5849 0038 3913 89 ❑Certified Mail Restricted Delivery TTT999 Return Receipt for I ❑Collect on Delivery Merchandise 2_n+fclo_Nr¢r her_1Transfpcfrom_serviceJabei) ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT" I � tail ❑Signature Confirmation I r. 7 015 1730 0001 4987 8333 tail Restricted Delivery Restricted Delivery my 2 N -90 Domestic Return Receipt r € PS Form 3811,J 015 PS 7530 02 000 53 COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE Flaherty Environmental Services . EL. 58.0' EL. 56.0' (not to scale) INSR PORT W I 3" OF GRADE CLEAN SAND P.O. Box 331 2" of e" to a" DOUBLE WASHED EL. 56.0' Harwich, MA 02645 4" CAST IRON or EQUIVALENT PEASTONE OR GEOTEXTILE ---�, 774.994. 1166 MIN. PITCH 114" PER FOOT FILTER FABRIC 4"SCHEDULE 40 PVC PIPE --- 4'SCHEDULE 40 PVC PIPE • Flow LINE VENT IF REQUIRED (/list 2'to be level) S' 2.2% 5' 1% ( L 53 ' L. EXIST 1 14" ®6 C���y Q.; . ' �O® 0 0 6 • •" EL. EXI EL.53.�5' —� c0o0o0°°° o00 0 ���LJL=1�© �, ®� °O°o°a°0° 0 0 0 0 0 0 0 00°°a0°OC f EL.53.03' 000 0 00000000 O�® M�En-pp. i ® 00000000c , ° 000000000000 0000o0o0c 2.0 EL 52.0' o°o°o°o°o°o°a°o° N�® ® 000000°oc— GAS BAFFLE o 0 0 0 0 0 0 0 � o 0 0 o c --� (H 20 D BOX) °000000000 00°0°0 °' ° ;0000o000C 00 0o EL,50.0' 6"CRUSH ID STONE OR SOIL ABSORPTION SYSTEM MECHANICALLY COMPACTED (2) SDO GALLON H-20 CHAMBERS 1000 GALLON SEPTIC TANK 5.0' (DATUM: ASSUMED) (EXISTING) 3" to 1�" DOUBLE WASHED STONE WITH 4' STONE AROUND IN A 4 2 12.83 X 25 X 2 CONFIGURATION BOTTOM OF TEST HOLE EL. 45.0' EL. 45.0' USGS ADJUSTMENT: N/A LOCATIONMAP GROUNDWATER ELEV: N/A HITCHING POST LANE NTH —`� •---_--- • gee 101.40, OdK 5 l 1 1 ,P � Hltch/ng Post Ln 58 �DRIVEWAI� LOCUS � •FS n LOT 24 1 1 58 0,35 ACRES± MAP 173 PLOT 36 GARAGE I NTS O% aYJ o EXISTING 1 56 ~ RAISED 3 BR DECK DWELLING -2TH-1 0 - EXIST. S.T. LP � ,.,:,•,. 20.8' chi Q Z l 56 BENCHMARK: DATE:31212021 REVISED: TOP OF FNDN EL. 58.0' 10.9' 140 / SITE AND SEWAGE PLAN LEGEND FOR -6-6-6--G— GAS LINE B& B EXCAVATION, INC.7 -W,---w _W W WATER LINE KAREN WEHLING e ��� E E. EXIST. ELECTRIC 29 PADLOCK ROAD 99 EXIST. CONTOURS (CENTERVILLE) 99 PROP. CONTOURS SCALE : 1" - 3 0' BARNSTABLE, MA j/Z U/4&• -u tr UNDERGROUND UTIL, REF.LCP 32851-B SH 2 PAGE I OF2 ......... ......... _ .._..... ........... .......... ........ ......... ......... .... ... ........ ........... ........ GENERAL NOTES DESIGN CALCULATIONS_ SYSTEM DETAIL Flaherty Environmental Services 1. ALL PRECAST COMPONENTS TO BE H-10 P. O . Box 331 RATED UNLESS OTHERWISE SPECIFIED. Harwich, MA 02645 DISTRIBUTION BOX AND ANY COMPONENTS NUMBER OFACTUAL BEDROOMS 3 774.994. 1166 WITH ANY ANTICIPATED VEHICULAR TRAFFIC TO BE H-20 RATED. GARBAGE DISPOSAL UNIT NO 2. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW FOR THE USE OFA GARBAGE TOTAL ESTIMATED FLOW GRINDER. (110 GAL/BR/DAYX 3 BR) 330 GAL./DAY 3. MUNICIPAL WATER IS AVAILABLE. REQUIRED SEPTIC TANK CAPACITY 660 GAL. 4. ALL CONSTRUCTION TO CONFORM WITH — 25, 310 CMR 15.000 AND ALL OTHER SIZE OF SEPTIC TANK 1000 GAL. (EXISTING) APPLICABLE LOCAL, STATE AND FEDERAL CODES AND REGULATIONS. SOIL CLASSIFICATION 1 5. INSTALLER/CONTRACTOR TO REVIEW& VERIFY ALL ELEVATIONS AND DETAILS AND DESIGN PERCOLATION RATE <2 MIN./INCH REPORT ANY DISCREPANCIES TO DESIGNER PRIOR TO CONSTRUCTION OR EFFLUENT LOADING ROTE 0.74 GAL./DAY/FTz O 12,83' ASSUME ALL RESPONSIBILITY. LEACHINGAREA 6. INSTALLER/CONTRACTOR IS RESPONSIBLE (2)x(25.0'+ 12.83)(2) = 151 SF FOR MAINTAINING SAFE WORK AREA, 25.0'x 12.83' =320 SF VERIFYING ALL UTILITIES AND NOTIFYING 471 SF 0.74 =348 GPD "DIG SAFE"(1-888-344-7233) 72 HOURS PRIOR TO CONSTRUCTION. USE(2)500 GALLON H-20 CHAMBERS WITH 4'STONE 7. ANY CHANGES TO OR DEVIATIONS FROM /NA 12.83'X25'CONFIGUR4TIONAS DIAGRAMMED THIS PLAN MUST BE APPROVED IN WRITING BY FLAHERTY ENVIRONMENTAL RESERVE LEACHING CAPACITY N/A SERVICES AND LOCAL BOARD OF HEALTH. — 8. FINISH COVER OVER COMPONENTS IS NOT TO EXCEED 3'PER 310 CMR 15.000 UNLESS SHOWN PER PLAN. 9. ALL ABANDONED SEPTIC SYSTEM COMPONENTS TO BE PUMPED DRY AND (NTS) FILLED WITH CLEAN SAND OR REMOVED AND REPLACED WITH CLEAN SAND. 10,ALL COMPONENTS TO BE PROVIDED WITH SOIL EVALUATION WATERTIGHT ACCESS PORTS WITHIN 6" OF FINISH GRADE. TESTHOLE#1 TPT#21-030 TESTHOLE#2 TPT#21-030 Evaluator- David D.Flaherty Jr,RS,REHS Evaluator- David D.Flaherty Jr.,RS,REHS 11.ALL SEPTIC TANKS, DISTRIBUTION BOXES SE#2755 I SE#2755 ZN of AND PIPING TO BE INSTALLED BON Witness: Dave Stanton,RS BOH Witness: Dave Stanton,RS 7.� � SSgc Date: February 22,2021 Date: f February 22,2021 WATERTIGHT. 12.NO KNOWN WETLANDS OR WELLS WITHIN t ' 150 FEET OF PROPOSED LEACHING. TH-1 ELEV.56.0' TH-2ELEV.56.0' F h� J 21 13.THIS IS NOT A CERTIFIED PLOT PLAN AND o°-9" A LS 10YR 3/2 0"-9" A LS IOYR 3/2 UNDER NO CIRCUMSTANCES IS THIS PLAN �S C'I s T ERa TO BE USED FOR ZONING OR BUILDING PURPOSES. 9"-32" B LS 10YR 5/6 9"-32" B LS 10YR 5/6 14.LOT IS SHOWN AS ASSESSOR'S MAP 173 LOT 36 . I5.LOCUS PROPERTY IS NOT LOCATED erc at 50" l certify that on November 12,2002,I have passed SITE AND SEWAGE PLAN the examination approved by the Department of FOR WITHIN AN AQUIFER PROTECTION Environmental Protection and that the above analysis DISTRICT(ZONE II), has been performed by me consistent with the B & B EXCAVATION, ZNC./ required training,expertise,and experience described KAREN WEHLING in 310 CMR 15.018(2)." 32"- 132" C FMS 2.5Y6/6 32"-120" C FMS 2.5Y6/6 29 PADLOCK ROAD (CENTER MLE) G.W.ELEV.N/A G.W.ELEV.N/A BARNSTABLE, MA BOTTOM TH-1 ELEV.45.0' BOTTOM TH-2 ELEV.46.0' PAGE 2 OF 2 DATE:31212021 ... ...... .__ . ..__......: I