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0029 PARK AVENUE - Health
29 Park Avenue Centerville .F/R A =_208 151 Slll $'.040or UPC 10259NO.W 1630R `�v. NAaTINOi, MN 1 - THE COMMONWEALTH OF MASSACHIlSETTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Yes 01pprication for Migpozal *pgtem Comaructiou Vermit Application for a Permit to Construct( )Repair�ade( )Abandon( ) fl Complete System El'Individual Components Location Address or Lot No. Owner's Name,Address and Tel.No. f Assessor's Map/Parcel 51 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. 27 Type of Building: Dwelling No.of Bedrooms Lot Size sq. ft. Garbage Grinder Other Type of Buildin /� . No.pf Persons Showers( ) Cafeteria( ) Other FixturesA R Design Flow. �Z 00 gallons per day. Calculated daily flow SL6 g:;>— gallons. Plan Date `7 a oZ Number of sheets Revision Date Title Size of Septic Tank / S a D G'o� 116 ti Type of S.A.S. ! S ovCW6 Description of Soil: Nature of Repairs or Alterations(Answer when applicable)® / A IV C/) SrJ "4,E20 / 3` X /3 u!61u ,i v ENUIN ER FUST S 1 EI N 12 vhi i 11%4,j Date last inspected: THE SYSTEM WAS INSTALLED IN STR!CT ACCORDANCE TO PLAN. 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 Certifi- cate of Compliance has been is b this Bo f Healt Signed Date Application Approved by Date © , Application Disapproved for the following reasons Permit No. aOoJ"ytl Date Issued U d 2 TOWN OF BARNSTABLE . LOCATION o ?"91Z tf Al SEWAGE #-�200o2 VILLAGE C E ter/ T i 2 l// 11'�e ASSESSOR'S MAP & LOT v /S/ INSTALLER'S NAME&PHONE NO./ 7 7-5 /.3",a SEPTIC TANK CAPACITY /,SCE T r 02 00,P Ti�17- 749 n/G/ LEACHING FACILITY: (type)C�� SD��, -�Sri 2 (size) NO.OF BEDROOMS 2 BUILDER OR OWNERS S C PERMITDATE: OMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility)' Feet Furnished by ,131) 2- i t s'v o D �aao 1 9 �- r , .y b('sf �• � � �,' y f •� ._.�.r �'a i' •4 TF -y t•r.ar r o. . 0. AF .r.* , Fee THE COMMONWEALTH OF MASETTS Entered in computer: SSAC U +-��✓/ Yes ' f —EaUBLIC'HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS , Appltcatto'n) or Mtgooar *p.9tem Con!5tructton Permit Application for a Pe`rrtiit,to Construct( )Repair(�Upgrade( )Abandon( ) '(1 Complete System n Individual Components Location Address or Lot No. / Owner's,Name,Address and Tel.No. Assessor's Map/Pazcel ' off- 151 Installer's Name,Address,and Tel.No. Designer's Name,Address a n Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder Other Type of Buildin yCo/m . No.of Persons Showers( ) Cafeteria( ) Other Fixtures t✓� R C�2 1 �/i /t 2 I Design Flow ;Z, cb 0 gallons per day. Calculated daily flow 31 a aD gallons. Plan Date �7 D oZ_ Number of sheets Revision'Date Title Size of Septic Tank ! S a d 6',4 116 IV Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable t° b r / �✓ li r .s�ov 5 % �9dk �/ s-v v C Gc 2 0 33 k 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 Certifi- cate of Compliance has been issued by this Board of Healt ' d Signed /' Date Application Approvegpy -Date fUr t n 4 Application Disapproved for the following reasons! ,. Permit No. - fOod -ytl g, Date Issued d 2 ' THE COMMONWEALTH OF MASSACHUSETTS Y BARNSTABLE, MASSACHUSETTS Certiftrate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed( )Repaired( )Upgraded( ) Abandoned( )by e .'i (, ,ST at a `7 /�t2 h' 4 Uf /.r ✓T c e has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. -)qU a'y`l dated d Installer Designer The issuance of this permit shall not be construed as a guarantee that the syste"'will f ction as"d s',gned. Date l = 1 K%2:0 A 1 Inspector I_ - �._ --------------------------------------- No. ?00.2— V I Fee S7 _ THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mizpooar bpotem Conotruction Permit Permission is hereby granted to Construct( )Repair( )Upgrade(-�-)Abandon( ) System located at -7 `7 1'�39 a h and as described in the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of t ' Date: t a it Approved by h� G.� T � w �� �= t Bk 34160 Pg256 #36580 05-28-2021 @ 11: 52a M DEED RESTRICTION WHEREAS, Laura A. Bete of 265 Washington Street, Hanover, Massachusetts and Timothy P. Buckley of 16 Oakland Avenue,Hanover, Massachusetts are the owners of Lot 2 and Lot 3 located at 29 Park Avenue, Centerville, Massachusetts (hereinafter referred to as Lots 2 and 3) and being shown on a plan entitled "Plan of Land in Centerville, Massachusetts, belonging to Philip E. and Patricia J. Paulin", dated May 26, 1972, drawn by Nelson Bearse-Richard Law, Surveyors, and recorded in Barnstab le County Registry of Deeds in Plan Book 160, Pace 45; i WHEREAS, Laura A. Bete and Timothy P. Buckley as the owners of Lots 2. and 3 have agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which s can be included in any home built on said lots as a pre-condition to obtaining a disposal works °j construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, v Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State 7 Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary `T Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of lzi bedrooms in any house constructed on the lots be put on record with the Barnstable County Registry of Deeds by recording this document; �-. NOW, THEREFORE, Laura A. Bete and Timothy P. Buckley do hereby place the following restrictions on their above-referenced land in accordance with their agreement with the Town of Barnstable Board of Health, which restrictions shall run with the land and be binding upon all successors in title: +� I. Laura A. Bete and Timothy P. Buckley agree to connect Lots 2 and 3 to town sewer when �- it is made available to them; and Q 2. Until such time as town sewer is made available to Lots 2 and 3,Laura A. Bete and Timothy P. Buckley may have constructed upon the lot a house containing no more than one (1) bedroom. Laura A. Bete and Timothy P. Buckley further state that this deed restriction affecting Lots 2 and 3 and being shown on the plan recorded in Plan Book 260, Page 45 shall expire and be of no further force and effect when they, have connected Lots 2 and 3 to town sewer. For title of Laura A. Bete and Timothy P. Buckley see the following deed: Book 33503, Page 176. i Bk 34160 Pg257 #36580 Executed as a sealed instrument this aA I day of May, 2021. Laura A. Bete Timothy P. Buckley COMMONWEALTH OF MASSACHUSETTS ss. May'``, 2021 On May ; 20?I before me,the undersigned notary public, personally appeared LAURA A. BETE and TIMOTHY P. BUCKLEY, proved to me through satisfactory evidence of identification, which was a Massachusetts Drivers License, to be the persons whose names are signed on the preceding or attached document, and acknowledged to me that they signed it voluntarily for its stated purpose. (seal,) f Notary Public MARC R. CLERC My commission ex Notary Public Commonwealth of Massachusetts My Commission Expires January 10, 2055 JOHN F. MEADE, REGISTER BARNSTABLE COUNTY REGISTRY OF DEEL P W..CWTvF.n C RF.rnQnF.n F:T.W.r.9'P0MTr AT.T.N i Commonwealth of Massachusetts o208- 151 Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name / information is required for every CENTERVILLE ✓ MA 02632 10/5/2020 page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector �' *F Information -1 on the computer, use only the tab Christopher Maki key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return Company Name key, 350 Main Company Company Address W Yarmouth MA 02673 CitylTown State Zip Code reran 508-775-2825 SI-14423 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 � g . � � 10/6/2020 Inspector's Signatu 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. t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18 f c Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name Information Is required for every CENTERVILLE MA 02632 10/5/2020 page. Cityrrown 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: ® 1 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: SYSTEM IS IN WORKING CONDITION 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 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE u Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. Cltyrrown 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): � I ❑ 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, safetyand the environment: t5insp.doc rev.7/2 612 0 1 8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. City/Town 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 ❑ ® 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 t Subsurface Sewage Disposal System Form -Not for Voluntary Assessments a 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name Informrequired is CENTERVILLE MA 02632 10/5/2020 required for every page. Cityrrown 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 Y2 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.7/2 2612 01 8 Title 6 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. Cityrrown 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? ❑ ® 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)] i t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is MA 02632 10/5/2020 CENTERVILLE required for every _ page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x'#of bedrooms): Description: Number of current residents: 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 ® 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 6 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 PARK AVE u Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: HAIR SALON Design flow(based on 310 CMR 15.203): 202 Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): 100 GPD PER CHAIR X 2 CHAIRS=200 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: 19-. 18- Last date of occupancy/use: CURRENT Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1500 gallons How was quantity pumped determined? SITE GLASS OPN TRUCK Reason for pumping: MAINTENANCE t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments y 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name Information is CENTERVILLE MA 02632 10/5/2020 required for every 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: 2002 PER ASBUILT CARD ON FILE AT BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No �. 5. Building Sewer(locate on site plan): Depth below grade: 31"feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 101+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND PROPERLY PITCHED t5insp.doc•rev.7/2612018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owners Name information is required for every CENTERVILLE MA 02632 10/5/2020 page, Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6, Septic Tank (locate on site plan): Depth below grade: 24"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: 1500 GALLONS Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? ESTIMATED Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500 GALLON TANK IN GOOD CONDITION. PVC TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL, INLET COVER AT GRADE. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 1s i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V, 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. Cityrrown 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: 2000 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 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments z Zia •'•y 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 _ page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ® Yes ❑ No Alarm level: 3/5TH Alarm in working order: ® Yes ❑ No Date of last pumping: 8/6/2020 Date Comments (condition of alarm and float switches, etc.): 2000 GALLON TIGHT TANK FOUND IN GOOD CONDITION "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 EVEN 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.): DISTRIBUTION BOX LEVEL AND WATERTIGHT t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE, Property Address TERRANCE WITTER Owner Owners Name information is required for every CENTERVILLE MA 02632 10/5/2020 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: ® leaching chambers number: 500 GALLON ❑ 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 c Commonwealth of Massachusetts r r r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. City/Town 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.): 1-500 GALLON CHAMBER FOUND DRY DURING INSPECTION WITH NO EVIDENT STAINING. 12. 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 Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i t5insp.cloc-rev.7/26/2018 Title 5 Official Inspection Form;Subsurface Sewage Disposal System-Page 14 of 18 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. City/Town 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 Commonwealth of Massachusetts Title 5 Official Inspection Form .' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r V� 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 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 t5insp.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 29 PARK AVE Property Address TERRANCE-WITTER Owner Owners Name information is required for every CENTERVILLE MA 02632 10/5/2020 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: +12' 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: 9/9/2002 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: TEST HOLE PER PLAN ON FILE AT BOH SHOWS NO WATER ENCOUNTERED AT 12'. PLAN SHOWS 5' MINIMUM SEPARATION 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 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 PARK AVE Property Address TERRANCE WITTER Owner Owner's Name information is required for every CENTERVILLE MA 02632 10/5/2020 page. City/Town 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 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 E a C.S 8 to r 8F 3�,s � F oeo � Q � r4.ov'T 9 - SOIL TEST taP ar fOLUTNM 20 FT.WIWN r aT awE ar sPc SESr Id ti.111t]�9i EI &f�Gt GM1r,9AGf C1yI164 s+uc TOR Tess auc eT ETFY- � woa7lm - CASiRmI rm 4'PTC P¢C PEI'1CalAiiCl1 4IA C 2 AT.$_ IYOQ f S7EDOE.a Pk rl 3r LA.L1 Or PMNW r AT DAD1 Yw PiTm iAr PER tldr D%Ir CFM ID spun& LEGEND. 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Tp+6�T 7 OP laK PL�I I7EdTED R 2.A11�TD SmAaWT UMM 9WL E§MOUWff 10 7➢4 s CF cwmc w w �AYD can.+r It',FPIe lxAe�y P, }qA v M.W.RT eM.w.!vu Q cAPA:e T > Ma DE�IM S A.•t WD(SIAIpK 1T.-16 W1a6 DIES D@T!�Om A Sf3101 • - LMr OQFrpri OF THE MWW TAN 0""R RC�rd.T3�A UM'r.l .R.OP aCTQ DP P.Ow AatA&I-=l.WOIID WVAL E ---P"WAr."T FACMY FW O uss'"'!i 1PaM CO W%10 IO s t Or=WS OR e1r�1OLAIL BL4 I,LK 1"Cr 3/4' 2 P-.~WYTRIIcm VIW R LRo[Ya SY Be TaIIL a NIr Y>�7iT lNS llSm 76�'3 CGQs m a11��aIIl j � 3.-ae Dh1�As I[G�+E+6 a7 •-"^'WFi l.LiHH D Sm'.MMWAmimi ri[W 1pPl ATZ iY1DDRT16 TIGHT TANK TITEE 3 AM B.O-K VARIANCES'• •UVull S s�a.If AYC.r�01IA8 DILT-m TAtw1l a�TRAcma r p 2CAi'�?-WC'Ai•�iN-►I7i AT U% 72 N006 ST5701 ETAa SLCTOP 113"ON pR,TAM[Cb PJMR ID LOYIIOKM.9'GIL(Oi FIL ` YO WALE 0 PSTAMM KrdlM 50-M TAW AND PW RT lAQ 7.OO11R!{Td[E 1O YHOT riIC10Ci 40 fillJNi10MS AS WOL AS C W1 A W wID.1FCt.RC6ifTlD SRL COQOP6 FIRM 70 nOOI 01 9TL Nfr++IMmF asrA1Q orr4W SAG 00 PRQEM W 4 m E WOUG T 70 lTE wTKMPpi E �[f� A Y WR1WC[IQa1ESi:J, .lARQL p W FLOOD 201W ( O�RAKK NCFMA iA-S AIO a'mt s7tXEL L!G1 6 PO>tM W w'aisORS YFP A=PNRGD�R A Y 1tMO am I[a"MD _ 10—tPa!•tDllY Y.Tm NOLL EE apowm rmw ND ECDOI ISM - - _ fall•YEYIIOI O a FELT PRiRF AR O M m AK71�IIdl 3f1'a1PC (D OILT Y O'CIMAR C-0 S AS CQW-Oghn M AUAMEU AID R lgIwEL4 WR1 SIP!E 17 M AB 0�73.II•s U3 'r 1,4 I - T- r 11�MIDI tO NEED'AD FLLD WM t1119 '' _� DNL s `•� APMVM BOARD OF W-&TH r 2a: _ ��r` / .� PEDPOS$D s 2r:s P6H ice.a ��t� - A��py ��y�pp CME����``�� EEa i8itiil L r' < 29 PARK AVE. J s - i l nr.rc ar / ` f AAA 4093f SF. � Au r n;e Al ;_OCATION MAP I. - l oFjHE Ta,, Town of Barnstable Regulatory Services • BARNSTABLE, 9 MASS. Thomas F. Geiler, Director i639• iOTEp�.(A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 August 4, 2003 On August 4, 2003 Sam White, RS spoke with Michael Moynihan (508-243-2732) who is the owner of 33 Park Ave., Centerville. He stated that during excavation of his property for an addition, he found an old septic system that had not been abandoned. He then had it properly abandoned. It turns out that the old system was for the adjacent property, 29 Park Ave. On October 3, 2002 Arch Construction completed the installation of a new septic system at 29 Park Ave. located in the front of the property. He apparently did not abandon the old system. Mr. Moynihan will be taking action against Mr. Wayne Archembeault, owner of Arch Construction for the cost of the abandonment of the old system. Samuel H. White, R.S. P�°F�►�r�,,,ti Town of Barnstabl e . P Department of Regulatory Services HA AM-BLE, M Public Health Division Date �oZ � A99. g � .% 39.t' 200 Main Street,Hyannis MA 02601 Date Scheduled Ti4me U.'0e 6h Fee Pd. t o Soil Suitability Assessment for Sewage Disposal Performed By: C I'Q 5 - � �� Witnessed By: - W "f w x r s 1 r » r M1 i 'ttNOW; : r41rc 'h :z y 1 t ,n Prr. Ly?4rP�''sm Lflr ,,s•... u f - ,� In1 owner's wy x�AR. �+:il._�.�•�`�n,ik��� .t:... n Location Address i➢l f K hV e- wner s Name r' !! Address f O n 00,1000"e Of ti3 Ole 0-1 cZ163Z Assessor's Map/Parcel: p t_ $ Engineer's Name C rN.'y SL'or NEW CONSTRUCTION REPAIR V Telephone# 4.510 8t- Cz / Land Use o�''��P—Fi d Slopes(%) l Surface Stones �a Distances from: Open Water Body /_�, /01/ Possible Wet Area J 1*� / rinking Water Well �ft Drainage Way _ft Property Line /,�/ ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in proximity to holes) \ .30,2 7 i • � moo, o, ID o hJ � s' 0 o Q. N N 0 Parent material(geologic) C . y Depth to Bedrock Depth to Groundwater: Standing Water in Hole: AJ O 15?e Weeping from Pit Face Estimated Seasonal High Groundwater m' _ :mo- % e4 -:'':r - r,ti;yiu_r;z EyN'i J: � �� � db',i., �� �'.�.cr.' � (?�R' w.9:. �I Y r e.v.R:n uA Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level_ Adj.factor Adj.Groundwater Level_ �:Sia;:F�ii°4' i 1 F'1 cF�Ili tt 2' P r•:Y w, ���, „y su i a:;'Nlre Fp"gli 7 �I` I+, w. 0 is'q' n'i�' '�s�l.�b:lE`"yl��.wa�'.�:.,I lei l H ryt"1y1:ry ��i qi:. .p:-...-.. •ila.0 'u'' .. M .F h IY`i. � .. i, uilG.�..�..,`>u,a�t a. Observation Hole# Time at 9" Depth of Perc �t .g Time at 6" Start Pre-soak Time Q ^7'"1 Z 4 Time(9"-6") a End Pre-soak Rate Min./Inch S Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) I Original: Public Health Division Observation dole Data To Be Completed on Back--- -- - I Q:HEALTH/WP/PERCFORM t+(�r H r;A I R.';:.:. °��!.i:s3dr":.iHri..e..`, � !...,. ice."!, t !.: T, ltJ�g tt,�"k't � k ... _�1 i-x t t r. t wr ru �. �! _.p.+3_ 1= _., ].F - A '>; ...< _I''_.- ..1,:k!!�. a� .. ...; '„tf,IL Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. Consistency,%Gravel o Z �+ S Zipio ' Z, 4 LA as Jy a ys ` ,mod of 4 2-7 Z S4 C, i�:-�a i a R ¢ Aio n3r.;i : ti t , � .i t R tt�l tr' tl H h I tld ffil 1r�j r ilt ( r t A. rk:u, aya �f+xi*:i(r >~ 4 t �i ,tis,5-:t.sR .� y- �rk,. «'fit. �' .:wa$'p,.. Esst't43�-M*.t..xr Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. a Consistency,%Gravel 4 _.,..:::.�,w.......,,:..:,: .... .,M<.�:w.. K,: -.,, �;n. ,. s.:e,,.....��_...,.�._....,:.:.:_��:_.. -a!x'- -,. .;•r=::ettit.s. ,,:y,..�. rv�c�:Pj,Y�:;'1;r ._�.......1.....:. kr��ffii��;�=```�'�k:l�r.�'K:k�:�y:.� P.k:, p,• ,Mf °t,F ,,}�'�kr.', j. � �,j�,v';r+c '`ri r�L;:'a;t;�ssy;�;7ir',�i����`'P��°'!::��#,�g•e: . - D .,v p. !tY: R� r -r .I:,,.ar, 1.::•s�eq#:3 , �,}�:d�I..u.Au: , ...�, 6 > � 3'� �R.'�.�:, 5..?lP5 t i+:...:... _.., �.Jit�::it,mnl�. < ,.t!aia ;-,<,�!�!.K<?� „t,a, '�.r...>+�!,.,..., DeptLEM h from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. [Consistency,%Gravel "g ". IAyt��ae r ��� � f -S.,H$S. ,,, Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling Structure,Stones,Boulders. -.Consistency,%Gravel Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes Within 500 year boundary No Y Yes Within 100 year flood boundary NOX Yes,. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? -71 G�� If not,what is the depth of naturally occurring pervious material? Certification I certify that on //omnental (date)I have passed the soil evaluator examination approved by the Department of Env Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature Date Q:HEAJTH/WP/PERCFO McKenzie, Marybeth From: McKenzie, Marybeth Sent: Thursday, April 29, 2021 1:35 PM To: 'timothy.buckley@comcast.net' Subject: RE: 29 Park Ave, Centerville Hi Timothy, I conferred with the Director Tom McKean and if you will need to submitted the following: *the second inspection report *a copy of a recorded deed restriction stating that you are only going to have one bedroom and that you will connect to sewer as soon as it is available to you *a floor plan showing all the rooms labeled and only one bedroom on the plan. Once all that is submitted I can proceed with the sign off for the building permit. If you have any questions please feel free to contact me. Sincerely, Marybeth McKenzie R.S. From: timothy.buckley@comcast.net [ma ilto:timothy.buckley(abcomcast.net] Sent: Thursday, April 29, 2021 8:38 AM To: Tripp,Vanessa Cc: McKenzie, Marybeth Subject: RE: 29 Park Ave, Centerville Hi Vanessa, thanks very much! Marybeth, would you let me know what exactly we need beyond the deed restriction again? I keep getting stuck since the current system is designed for 200 gpd and we are restricting via the deed to one bedroom only which requires 110 gpd. We will provide anything that you require naturally...I just want to make sure it is the right thing! Please feel free to call my cell at: 781.243.9350. Thank you. TPB From:Tripp,Vanessa <vanessa.tripp town.barnstable.ma.us> Sent:Thursday, April 29, 2021 8:24 AM To:timothy.buckley@comcast.net Cc: McKenzie, Marybeth <Marybeth.McKenzie town.barnstable.ma.us> Subject: 29 Park Ave, Centerville Good Morning, Please see attached sample of deed restriction and copy of plan. Thank you, Vanessa Tripp Lead Permit Technician Town of Barnstable Health Division 200 Main Street Hyannis, MA 02601 Phone: 508-862-4644 1 The information contained in this electronic transmission("e-mail"),including any attachment(the"Information"),may be confidential or otherwise exempt from disclosure.It is for the addressee only.This Information may be privileged and confidential work-product or a privileged and confidential communication.The Information may also be deliberative and pre- decisional in nature.As such,it is for internal use only.The Information may not be disclosed without the prior written consent of the Director of Public Health and/or the Town Attorney's Office of the Town of Barnstable.If you have received this e-mail by mistake,please notify the sender and delete it from your system.Please do not copy or forward it.Thank you for your cooperation. CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 CRAIG R., SHORT, P. E. 235 Great Western Road P.O. Box 1044 Telephone(508)398-8311 South Dennis,MA 02660 Fax (508)398-3063 PROFESSIONAL CIVIL ENGINEER, SOIL EVALUATOR, SEPTIC INSPECTOR SEPTIC SYSTEM DESIGNS,COASTAL&BUILDING DESIGNS TO: Thomas McKean Health Director Barnstable Board of Health 200 Main Street Hyannis,MA 02601 RE: CERTIFICATION OF SUBSURFACE SEWAGE DISPOSAL SYSTEM LOCATION OF SYSTEM: 29 Park Avenue,Centerville,MA(Barnstable) CLIENT: Mark Scibelli PLAN DATE: 09/09/02 FILE#: 1-906 DATE(S)OF/TYPE OVINSPECTIONS: 1U%18702-'= Inspect Tank,Tight Tank&500 Gallon Drywell 10/18/02 Measure for As-Built :10/30/02_ _:Alarm_Floats in,.no.alarm seen i 11/04/02 "Inspect Alarm;plumbing to sanitary system& cesspool filled in with sand. I, Craig.R. Short, Civil Engineer, duly licensed as such in the Commonwealth of Massachusetts, do hereby certify that this firm has visually inspected the constructed subsurface sewage disposal system shown on the referenced approved plan, and further certify that the system, as constructed and shown on the attached As-Built, (copies of photographs taken in file) generally conforms within acceptable tolerance to the regulations, as varied, set forth in 310 CMR 15.000 and the Town. of Barnstable Board of Health Regulations,with the following exceptions: As of 11104102 The Vent Pipe was not installed,since the owner is not paving,but putting a gravel pervious finish grade: The septic system has been connected to the plumbing but a sink for dyes has not been connected to the tight tank. No cover to grade for D.B.,only on each tank. p i /,3 v Craig hurt,P.E. Engineer - Date cc: File-1-906 Client Mark Scibelli '`' 'Contractor Arch Construction. 10/29/2002.- 1 ;08 5087789629 AB CANCO rHUc ul'�1 iAOouCffl7 �I�a�AroMt.Ws:glAil,'marCmPMONEIUIIFpli1*BOOa7f�8110 •'. � � r_ ^—+.'�`— Proposal Page No. of Pages 350 Maln St: P.O.BoY 999 WEST YA19MOUTM,'MA 02673 Phone,(506)175-2800 PROPOSAL SUHNITTED TO DATE lot ADDRESS PMOHE DATE OFP S CA- , 1 JOB NAME AN-0—LOCATION ARMTECT 1 JOB PHONE We hereby sabmlt spaciticitloRs Mad estimates,subject to all terms and condttlOni as set forth on both sides,as follows, .........:.................................I,,, ..... � ...,......... v\ C. 4 Lo`.�. k9�OQXAL .................... ...,,,„,............... Q s ��' Z-' !�- - v..2.,....�...t-'V�. ..:...........:�' ...p o............................................................ ............. .......... ..... .................. ..,,,,,,...,. ... .., . m S '' m .....;�....� T(A�� ..........................fie........:�:.:............_�-,c��..l.-sL......,..... ..... ...�,�•�"..,,,..,,................ .............:..... • -r, ........... ...... �,.�.�...................... *ACO'V\ (Read Reverse Slde) me TLa106t fmovy ip fumirh mateMal and labor a011110tete in accordance WRfi atom speaficetlons, for the sum of:—_.. n .dollars(S Note: This prOp0091 rtl,iy be withdrawn by uS If Aye not ameptod within—. ` 0 days_ •Slpaaju;I s111� ! Twe ebewl prleeq,apeclflratlone and condltloneare eatsraetOryalwdamhanbyeaa®pted,You gtgnetum are euthorimd to do tho v erh as apeelAad.Payment will De made as outlined abw-% Date �gReture PRODUCr41i I1�te.,Onlva taml•�S7.ToeroervleplE teLtPAEE I�00iy48p r - 1"-e'/ COMMONWEALTH OF MASS-ACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS r a a DEPARTMENT OF ENVIRONMENTAL PROTECTION y 20 RIVERSIDE DRIVE, LAKEVILLE, MA 02347 508-9.46-2700 /El ARGEO PAUL CELLUCCI -For rU l 3 J Governor BOB DURAND Secretary JANE SWIFT , LAUREN A.LISS Lieutenant Governor Commissioner August 28,2000 Craig Short,PE RE: Y UTH--Beauty Parlor PO Box 1044 Permit to ct So. Dennis,Massachusetts 02660 Non-Sanitary tewater Tank BRP WP56 Transmittal#122069a Dear Mr. Short: DEP has recently completed a review of Massachusetts regulations and programs which affect businesses discharging or proposing to discharge industrial wastewater through connections only to public sewers..Industrial wastewater includes wastewater.resulting from processes of industry,trade, or business,regardless of volume or pollutant content. Wastewater containing only sanitary[bathroom] sewage,non-contact cooling water,.compressor or air conditioner condensate is not industrial wastewater. The regulations reviewed include 314 CMR 7.00: Sewer System Extension and Connection Program,and 314 CMR 12.00: Operation and Maintenance and Pretreatment Standards for Wastewater Treatment Works and Indirect Dischargers. As a result of the review,we will be proposing new rules that we believe will improve the overall environmental performance by industrial dischargers by better supporting Publicly Owned Treatment Works' pretreatment programs. In anticipation of these changes,DEP at this time is not requiring the payment of DEP permit fees nor the submissions to DEP of sewer connection permit applications including the required industrial wastewater treatment facilityplans and specifications, industrial waste holding tank approvals and non-sanitary industrial wastewater holding tank approvals, except as detailed in item 4 below. DEP will provide notification to you of proposed new regulatory requirements that may apply to your facility as soon as available. To ensure that existing Ao darrds are met while applying this policy,please note the following requirements: 1. If you are W existing sewer user or plan to discharge to a sewer and you do.not have a permit,DL7P will.3tAt cite a violation for such lack,of permit. You must comply, however,with ft f'equirements of 314 CMR 12.00: Operation and Maintenance and tre=Ment SUMdards for Wastewater Treatment Works and.Indirect Dischargers and 257 CMR 2.00.,, Certification of Operators of Wastewater Treatment Facilities. This Wff**flM 1s aH ble in dfermto format by caUia�}ourADA Coordiestor:at(627)57446M. DEP OR Me WWW Me Web: hWJM6ww.rMgheLstWe.ma.us/dap Pdnted on Regcbd Paper . v ` 2 2. If you have a.currently valid DEP permit,you must comply with its requirements. When existing permits expire,their requirements will extend until new regulations are promulgated. Facilities requiring modifications will be considered on a case-by-case basis. 3. If you are a facility with a new permit application or a permit renewal application in process at DEP and you have paid a.fee,DEP will initiate action to return the fee upon receipt of a.written request that you are withdrawing the application with reference to this letter and that DEP should discontinue the review process. If you prefer,you may request in writing that DEP continue the review process. DEP will retain the fee, complete the review and deliver a decision issuing or denying the permit. 4. If your facility's non-sanitary industrial wastewater holding tank/disposal system includes the use of an alternative technology to supplement or replace a holding tank, such as an evapotranspiration system,'or has an on-site discharge to supplement the holding tank,the system still requires review and approval by DEP, including submission of the applicable permit application,plans, and fee. 5. This policy does not apply to facilities subject to DEP enforcement actions.Return to - compliance requirements may include DEP permits and plan approvals. 6. Existing or proposed facilities whose business activities may constitute a significant threat to the environment may be required.to obtain a DEP permit and/or plan approval. Please be.advised;the lack of'permitting action by the Department:at this.time does not:negate the necessity to install an industrial'waste holding-tank in accordance with all provisions of the Department's permit:application package. You must still.seek and obtain approval from the local Board of Health and conform to all required monitoring:and maintenance. - DEP will retain your name on file to notify you, in writing,of requirements under the revised Industrial Wastewater Sewer Connection Program when they become available. If you need additional information,_please contact John Viveiros at(508) 946-2859. Very truly yours, Elizabeth A. Kouloheras, Chief Cape Cod Watershed K/JV/cb cc: Bruce Murphy,Director Board of Health 1146 Route 28 Yarmouth,MA.02664 f cc: Jim.Kennedy Amy Lynn's Salon Sexee 1126 Route 28 So. Yarmouth,MA 02664 Yarmouth-Dennis Septage Treatment Facility 47 Workshop Road Yarmouth,MA 02664 DEP-SERO ATTN: Jeffrey Gould Brian.Dudley Christos Dimisioris Lori Rogers i TOWN OF BARNSTABLE �C LOCATION o�� � �7U SEWAGE ASSESSOR'S MAP & LOT a !2rY/5 VILLAGE— - ' INSTALLER'S NA &PHONE NO. G l—) � ME SEPTIC TANK CAPACITY /,S v 0 r r c- 02 DOo 7t . LEACHING FACII.ITY: (type)�/� -S-60 �''`t`S'r (size) NO.OF BEDROOMS- BUILDER OR OWNER �� C PERMITDATE: I o ) 3I U.p COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility.(If any wetlands exist Feet within 300 feet of leaching facility) Furnished by 01 =p�v OQ4Z° a O v v n-t S'�� G ��� PROJECT.' 9ES'C111PTION: 5 E p7j C S Y S T C M AS 8 U/L T " r ti -__-T�--'--_-OF ae vFO!_ZU'TN__a_A,4T>O v N JSF,=T/ C C t A/ 54 97. 7.r OVTE_t_97. 2G S. ri . S. I•�r EL 97- 72 Aj —'---- T1_4 IV EL 01 7,S S A.6 20, 1 ' Fq /7.4 ' �42 A C 25.1' FC 2Z.S / s 4 P 20 Member ASCE •� FOR: MAIRK .5C/,BFL4Z* . CRAIG.R..SHORT, P.E. P.O.BOX 1a" LOCUS: 2 sour-t DENNIS,MA 02660 Professional Civil Engineer-Soil Evaluator i? TOWN• �/�/T��1//L�. Ucensed:Construction Supervisor Septic Inspector '' CIVIL .; No.27483 i Septic«Site•Piers.-structures•House Designs .off R "`>' I)n•rl•: � . /a2 I'II,1; Il. 06 Office:(508)398-8311 Fax:(508)398-3063 . �i�t �, 02 s COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION. ONE WINTER STREET, BOSTON MA 02108 (617)292-5500;15 � % <000 r TR 1 Secs tarry ARGEO PAUL CELLUCCI DAVID B.STRUHS Governor Commissioner SUBSURFACE SEWAGE DISPOSAL S INSPECTION FORM PART A �O CERTIFICATION Property Address: 29 Park Avenue, Centerville, MA Name of Owner: Estate of Phillip Paulin Address of Owner: c%Sykes&Cole Date of Inspection: June 12, 2000 420 South Street, Hyannis, MA 02601 Name of Inspector: (Please Print) James M. Ford I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) Company Name: James M. Ford Mailing Address: P.O. Box 49, 0sterville, MA 02655-0049 Map: 208 Telephone Number: (508)862-9400 Parcel: 151 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below,is true,accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: Passes Conditionally Passes _ Needs Further Eval i n By the Local Approving Authority ✓ Fails Inspector's Signature: Date: June 15, 2000 The System Inspector shall sub it a copy of this inspection report to the Approving Authority(Board of Health or DEP)within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ,fig. NOTES AND COMMENTS w revised 9/2/98 Page 1of11 Printed on Recycled Papa SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 INSPECTION SUMMARY: Check A, B, C, or D. A. SYSTEM PASSES: _ I have not found any information which indicates that any of the failure conditions described in 310 CMR 15.303 exist. Any failure criteria not evaluated are indicated below i%% COMMENTS: B. SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Indicate yes,no,or not determined(Y,N,or ND). Describe basis of determination in all instances. If"not determined",explain why not. The septic tank is metal,unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance(attached)indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank,whether or not metal, is cracked,structurally unsound,shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a complying septic tank as approved by the Board of Health. Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s) or due to a broken,settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health) broken pipe(s)are replaced obstruction is removed distribution box is levelled or replaced The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed revised 9/2/98 Page 2of11 r ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 C. FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES IN ACCORDANCE WITH 310 CMR 15.303(1)(b) THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER,IF ANY)DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private water supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well,unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approidmation not valid). 3) OTHER revised 9/2/98 Page 3of11 . V SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 D. SYSTEM FAILS: You must indicate either"Yes"or"No" as to each of the following: ✓ I have determined that one or more of the following failure conditions exist as described in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged 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 lh 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 Soil Absorption System,cesspool or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable,attach copy of well water analysis for colifonm bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. Note. The system is a single cesspool, which is a failure in the Town of Barnstable. E. LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No 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 H of a public water supply well The owner or operator of any such system shall upgrade the system in accordance with 310 CMR 15.304(2). Please consult the local regional office of the Department for further information. revised 9/2/98 Page 4of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 Check if the following have been done: You must indicate either"Yes" or"No"as to each of the following: Yes No ✓ Pumping information was provided by the owner,occupant,or Board of Health. *✓ None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. (*The property has been vacant for some time.) n/a As built plans have been obtained and examined. Note if they are not available with N/A. ✓ The facility or dwelling was inspected for signs of sewage back-up. ✓ _ The system does not receive non-sanitary or industrial waste flow. ✓ _ The site was inspected for signs of breakout. ✓ _ All system components,excluding the Soil Absorption System,have been located on the site. ✓ _ The septic tank manholes were uncovered,opened,and the interior of the septic tank was inspected for conditions of baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge,depth of scum. The size and location of the Soil Absorption System on the site has been determined based on: ✓ Existing information. For example,Plan at B.O.H. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue,approximation of distance is unacceptable) [15.302(3)(b)]. ✓ _ The facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of SubSurface Disposal Systems. I I revised 9/2/98 Page 5of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 FLOW CONDITIONS RESIDENTIAL: Design flow: g.p.d./bedroom. Number of bedrooms(design): Number of bedrooms(actual): Total DESIGN flow Number of current residents: _ Garbage grinder(yes or no): Laundry(separate system)(yes or no):_; If yes, separate inspection required Laundry system inspected(yes or no): Seasonal use(yes or no): _ Water meter readings,if available(last two year's usage(gpd): Sump Pump(yes or no): _ Last date of occupancy: COMMERCMVINDUSTRIAL: Type of establishment: Barber shay (with one seat) Design flow: n/a ead(Based on 15.203) Basis of design flow The building is approximately 300 sa. ft. Grease trap present: (yes or no) No Industrial Waste Holding Tank present: (yes or no) No Non-sanitary waste discharged to the Title 5 system: (yes or no) No Water meter readings, if available: No readings available-per Water Department. Last date of occupancy: Unknown OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: None on file-per treatment plant. System pumped as part of inspection(yes or no): No If yes,volume pumped: gallons 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) I/A Technology etc. Attach copy of up to date operation and maintenance contract Tight Tank Copy of DEP Approval Other APPROXIMATE AGE of all components,date installed(if known)and source of information: Unknown Sewage odors detected when arriving at the site: (yes or no) No revised 9/2/98 Page 6of11 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 BUILDING SEWER: _ (Locate on site plan) Depth below grade: Material of construction: _cast iron _40 PVC _other(explain) Distance from private water supply well or suction line Diameter Comments: (condition of joints,venting,evidence of leakage,etc.) SEPTIC TANK: None m (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ Is age confirmed by Certificate of Compliance_(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 dimensions were determined: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) GREASE TRAP: None (locate on site plan) Depth below grade: a 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: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage,etc.) revised 9/2/98 Page 7of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 TIGHT OR HOLDING TANK: None (Tank must be pumped prior to,or 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/day Alarm present: Alarm level: Alarm in working order: Yes_ No_ Date of previous pumping: Comments: (condition of inlet tee,condition of alarm and float switches,etc.) DISTRIBUTION BOX: None (locate on site plan) Depth of liquid level above outlet invert: Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box,etc.) PUMP CHAMBER: None (locate on site plan) Pumps in working order: (Yes or No) Alarms in working order: (Yes or No) Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) revised 9/2/98 Page 8of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 Park Avenue, Centerville,MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 SOIL ABSORPTION SYSTEM(SAS): None (locate on site plan, if possible; excavation not required, location may be approximated by non-intrusive methods) If not located,explain: Type: leaching pits, number: leaching chambers,number: leaching galleries,number: leaching trenches, number, length: leaching fields,number, dimensions: overflow cesspool,number: Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.) CESSPOOLS: ✓ (locate on site plan) Number and configuration: 1 single cesspool Depth-top of liquid to inlet invert: -- Depth of solids layer: -- Depth of scum layer: — Dimensions of cesspool: S'W x 8'T x 10'bottom to grade Materials of construction: Cesspool block Indication of groundwater: None inflow(cesspool must be pumped as part of inspection). Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.) The cesspool was dry. The scum line was]'up from the bottom. PRIVY: None (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.) revised 9/2/98 Page 9of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 Map: 208 Parcel: 151 SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent reference landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) z13 y(o PIS (3rus 'ret �.►a. 1� 4- tr.ow s i r�Q- O revised 9/2/98 Page 10of11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 29 Park Avenue, Centerville, MA Owner: Estate of Phillip Paulin Date of Inspection: June 12, 2000 NRCS Report name Soil Type Typical depth to groundwater USGS Date website visited Observation Wells checked Groundwater depth: Shallow Moderate Deep SITE EXAM Slope Surface water Check Cellar Shallow wells Estimated Depth to Groundwater Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observed Site(Abutting property,observation hole,basement sump etc.) _ Determined from local conditions ✓ Checked with local Board of Health Checked FEMA Maps Checked pumping records Check local excavators, installers ✓ Used USGS Data Describe how you established the High Groundwater Elevation. Must be completed) Using the Barnstable topographic map and water contours map, the maps were showing approximately 28' +/- to groundwater at the building site. The cesspool is out back, at a lower elevation, in a highly vegetated, wooded area. I could not auger in this area. This report has been prepared and the system inspected and failed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no'warranties or guarantees, either expressed, wriuen or implied, relating to the system, the inspection and/or this report; revised 9/2/98 Page 11of11 BMCHg TOP OF FOUNDATION 20 FT. MINIMUM FROM CELLAR SOIL 'TEST ELEV. _ 100•DO- I� j. 1�INI1�UIJI 1� fT, MtN1A1NM fRaM $4A� QR GRAM $PACE DATE OF SOIL TEST 8 4 Q2 -LLCAN SAND ORT.�E. (ASSUMED) 24" DIA. HEAVY DUTY CAST IRON SOIL 'TEST.DONE BY G R.�{ FRAME AND COVER BROUGHT TO WITNESSED BY _DA� 5��� FINISHED GRADE OBSERVATION HOLE 1 ELEV. 100.7 4' SCHEDULE 40 PVC PIPE 4" PVC PIPE PERCOLATION RATE ,L2_ MIN. NCH AT ' - 0 INCHES MIN. PITCH 1/8" PER FT: 2 LAYER OF PAINTED FLAT DARK . 1/8" 10 1/2" GREEN OR BROWN LEGEND: DEPTH HORIZ TEXTURE, COLOR MOTT. OTHER 100.75 MAX. WASHED STONE WITH CARBON FILTER EXISTING SPOT ELEVATION 00„0 2,5' 4" CAST IRON PIPE 100.5D MIN. IS REWIRED EXISTING CONTOUR ----00---- 2' FILL ASPHALT (OR EQUAL) MINIMUM X FINAL SPOT ELEVATION SAND PITCH 1/4" PER FT. H2O FINAL CONTOUR 0 420 B do GRAVEL 10YR5/6 NO 97.20 SOIL TEST LOCATION / FLOW LINE �' 97.25 H2O Q1 UTILITY POLE -0- 72° C1 �SE SAND 10YR6/4 `NO PLUMBING ELEV. s 97.50_ MIN" O ❑❑ O❑ 0 O ❑ ❑O O TOWN WATER -WSW 0 o e CATCH BASIN ®l 2 144" c2 �OARSE sANO 10YR7/4 No TO BE RAISED ELEV. - 97•� LEVOEL i o o ❑ O O❑❑O O❑ O O O ° GAS LINE AND RE-PIPED BY ELEV. Q �' Z��_ GAS 6" SUMP 98. __ o o o C LICENSED PLUMBER BAFFLE ELEV, a �_7S ELEV. _ e o O 0 0 0 0 O O O O L7 ❑ o ;�� o CLEAN OUT AS NEEDED DISTRIBUTION e e o o CESSPOOL C.P. t� H2O ELEV. 0 00000000000 o 0 94.50 LIQUID OUTLET BOX -��.I� o ELEV. 4 FEET 14 INCHES DEPTH TEE (TO BE PLACED ,ON FIRM BASE) TO BE WATER TESTED 1 500 GALLON DRYWELL WITH 5 FEET 19 INCHES IF MORE THAN ONE OUTLET STONE IN AN 6 FEET 24 INCHES 5D0 GALLON 7 FEET 29 INCHES (TO BE PLACED ON FIRM BASE) 13' X 13' X 2'TRENCH FORMATION WELL N A NO WATER ENCOUNTERED AT 12• ELEV. s RA 7 8 FEET 34 INCHES SEPTIC TANK 3/4" TO 1 1/2" CLEAN SOIL ABSORPTION s.e' INDEX ONE_1 e FREE OF FINES dc SStaLJTE (SAS) ADJUSTIDOUBLE WASHED C ) DESIGN CALCULATIONS USGS PROBABLE WATER TABLE ELEV. = N/A_- NUMBER OF BARBER CHAIRS 2 SEWAGE DISPOSAL SYSTEM PROFILE OBSERVED WATER TABLE ( J / ) ELEV. _ _NIA_, TOTAL ESTIMATED FLOW NOT TO SCALt BOTTOM OF TEST HOLE ELEV. _ 1 ( 100 GAL/BR./DAY X ...2_ BR.) �4SL GAL./DAY TOP OF FOUNDATIONREQUIRED SEPTIC TANK CAPACITY 5,09 GAL. ACTUAL SIZE OF SEPTIC TANK 1,500 GAL. ELEV. _ .100.00 24" DIA. HEAVY DUTY CAST IRON SOIL CLASSIFICATION • FRAME AND COVER BROUGHT TO DESIGN PERCOLATION RATE Ste- MIN./IN. FINISHED GRADE EFFLUENT LOADING RATE -DJ4_ GAL./DAY/S.F. LEACHING AREA 273_ SO. FT. 10' MINIMUM (I 3'x13')+(52'x2') LEACHING CAPACITY (AREA X RATE) 292 GAL./DAY 273 X 0.74 2.5' 4" SCHEDULE 40 PVC PIPE (OR EQUAL) NOTES: TIGHT TANK RESERVE LEACHING CAPACITY GAL./DAY MIN. PITCH 1/4" PER FT. I ALARM CONTROL BOX 1. ALL WORKMANSHIP AND MATERIAL SHALL CONFORM TO D.E.P. TITLE 5 AND THE TOWN CONNECTED TO ALARM RULES AND REGULATIONS FOR DISPOSAL OF INDUSIAIAL WASTE (HAIR CHEMICALS). AT BUILDING 8 2.ALL MANHOLE COVERS SHALL BE 24" HDCI BROUGHT UP TO FINISHED GRADE.. NOTES: • \ re f 3.EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY THE SAME. `ELEV. _ � _' 4 SPOOL SHALL BE PUMPED AND FILLED�IN WITH SAND OR-'REMOVED. 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. ALARM ACTIVATION LEVEL EXISTING CESSPOOL TITLE 5 AND THE TOWN RULES-AND-REGULATIONS FOR-THE SUBSURFACE 5'-7" (3/5 OF TOTAL DEPTH) 5.TIGHT TANK SHALL BE ASPHALT COATED AND HAVE: 6 ML POLY ATTACHED TO THE DISPOSAL OF SEWAGE. ELEV. _ 97_23 OUTSIDE OR BE IPX TREATED BY MANUFACTURER / 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO 6.TIGHT TANK SHALL BE CAPABLE OF WITHSTANDING H-20 LOADING. 3'-4 7:THE ALARM SWITCH SHALL BE CONNECTED TO A BELL AND LIGHT ALARM LOCATED IN WITHIN 6" OF FINISHED GRADE. H2O THE BUILDING. 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL. BE CAPABLE OF 8.ALL rONTENTS OF THE HOLDING TANK SHALL BE REMOVED TO A LICENSED Z N Dv s r 2 J.4 L WITHSTANDING H-10 LOADING UNLESS THEY ARE UNDER OR WITHIN ETA K A IRM, wrzurMEATMENT FACILITY FOR DISPOSAL. 10 FT. OF DRIVES OR PARKING AREAS. H�-20 LOADING SHALL BE BASE (I.E. 6" LAYER OF 3/4" - 9.PUMPING CONTRACTOR MUST BE LICENSED BY THE TOWN. USED UNDER OR WITHIN 10 FT. OF DRIVES OR PARKING AREAS. 1 1 J2"�STONE) 4. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE SHALL 2000 GALLON BE MORTARED IN PLACE. T� 5. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH TIGHT TANK DEEDED OR ZONING REGULATIONS. OWNER / APPLICANT IS TO . TITLE 5 AND E.O.H.- VARIANCES: OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. + 6. UTILITIES SHOWN ARE APPROXIMATE ONLY, EXCAVATION CONTRACTOR SYSTEM DETAIL SECTION 15.211 MIN DISTANCES: IS TO CALL "DIG-SAFE" AT 1-888-344-7233 AT-LEAST 72 'TOURS NO SCALE PRIOR TO COMMENCING WORK ON SITE. E6� 9.8 D DISTANCE BETWEEN SEPTIC TANK AND PROPERTY LINE 7. CONTRACTOR IS TO VERIFY GRADES AND .ELEVATIONS AS WELL AS A 8' VARIANCE REQUESTED. SITE CONDITIONS PRIOR TO,COMMENCING.WORK ON'SITE. ANY VARIATION DISTANCE BETWEEN S.A.S. AND PROPERTY LINE IS TO BE BROUGHT TO THE ATTENTION OF THE DESIGN ENGINEER . A 5'. VARIANCE REQUESTED. IMMEDIATELY. p,�'� I DISTANCE BETWEEN S.A.S. AND WATER SERVICE. B.-PARCEL IS IN FLOOD ZONE . C / 1' VARIANCE REQUESTED. 9. LOT IS SHOWN ON ASSESSORS MAP 268 AS PARCEL - / A V C10. ALL UNSUITABLE MATERIAL SHALL BE REMOVED FROM UNDER, AND • 84.6 j �-� SECTION 15.221: FOR A MINIMUM OF 5 FEET FROM AROUND THE SOIL ABSORPTION SYSTEM, ONLY 3' OF COVER OVER S.A.S. COMPONENTS IS ALLOWED. AND BE REPLACED WITH SAND AS SPECIFIED IN 310 CMR 15.255: `(3) /\ �(94) A 0.5' VARIANCE REQUESTED. _ .(I.E. TITLE 5) IF ENCOUNTERED BELOW•S.A.S. PIPE INVERT. 11. *trt OR REMOVED PTIC SYSTEM TO BE PUMPED AND FILLED WITH SAND / .C°Mrs �' `� �� �� 4�; � + APPROVED: BOARD OF. HEALTH R9o.27�+1151 9I°Z DATE AGENT 1 00 99.2 PROPOSED SEPTIC DESIGN m�D 4" VENT sre)G� fZ T $ FOR al, : MARK SCMEL]LI 9 1005 F• -:. 0 EXISTIN 0)• y r► / g• UILDING �--- 2 LOC. 29 PARK AVE .. . 99. �� ,00 5 , 2 ..CENTERVRLE1 �S r,mr, "PVc PIPE 4ocus �'� 100.5 SLEEVE AT WATLrR ca D,'/ LOT 111 �0.2 U E UNE CROSS1Nc ~''s z•.rc CL1til it : SHa ?; =P. I /� I FROM BUILD/NC ) t ro sEPnc ,eo. � �+ 235 <GREAT -WESTERN ROAD AREA 'Q�93� ,SF _ / �0.4 508- P H 80X 1044 I o, TAAIKS @ 398-8311 SOU DENNIS, MASS. 02660 99. \ 0. 50 DATE SCALE. n ,00.6 P, 9/qjo� 1 20 I r REVISED JOB NO. !�"`9OV 00. o � . REVISED LOCATION MAP SHEET 1 r OF .1 C. S8 PROD JJ8-00 dw 2J -OD.DWO 0 2002 CRAIG.R. SHORT. .P.E."