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HomeMy WebLinkAbout0325 PATRIOT WAY - Health 125 Patriot Way Centerville P A = 193 173 I I $f/ llll � Now 12543 wecr�pp� 6pN Y lit � f� - 7 No. 0CU � Fee �v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:t� Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Applitation for Disposal 6pstem Construttfon permit Application for a Permit to Construct 'Repair(Upgrade( ) Abandon( ) [:]Complete System 'Individual Components Location Address or Lot No._j25— jt rR /o r kji4l, Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / ._/ In taller's N m Add ss and Tel.No,j a"�/2Z — g 73dA Designer's Name A dress and Tel.No.S d$�3wO—3j/ ,�as��� -e Wino 1115x_ ,; ors-xnrif. /(-,4,--�,"W-4, 9X, Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided 333 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 1 uw X Type of S.A.S. U G Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by l.G. Date Y Application Disapproved by Date for the following reasons Permit No. Date Issued A LO.CATION / ( SEWA E PERMIT NO. ' 7 `I S VILLA'G,E 173 IN-STA LLER'S NAME & ADDRESS 3dNL�s. BURDER OR 0 NER DATE/ PERMIT ISSUED DATE COMPLIANCE ISSUED ry / w 5 � ` �i •:r TOWN OF BARNSTABLE LOCATION = � IPA-ri? 10 d SEWAGE# D /(o Orin 0 VILLAGE C F IV 3-&=K isiZL ASSESSOR'S_MA 7P&PARCEL 193 ' / INSTALLER'S NAME&PHONE NO. /o P!^�`i Jai_ �t Yy'O S SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (type) 6 L.0 1_►� �size) f;?_�5_ X NO.OF BEDROOMS_ OWNER V// // PERMIT DATE: 3 Z/ /G COMPLIANCE DATE: ZI /G 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 r 13ia C"f A A /32- -W32s- A 3 No. D _ - ' Fee v THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: / TOWN OF BARNSTABLE, MASSACHUSETTS des PUBLIC HEALTH DIVISION j application for Disposal *pstrm Construction Permit Application for a Permit to Construct(4'- -Repair(4<fIpgrade ') Abandon( ) [:]Complete System 2-Individual Components t Location Address or Lot No. 5 C? / �`32 — � Owner's Name,Address,and Tel.No. Assessor's Map/Parcel / 3—/7 Instal.r' Addx ss and Tel No.j- �/2G- q 7 3� Designer's Name;Address,and Tel.No. E/ Types of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures -7 Design Flow(min.required) 3 0 gpd Design flow provided 33 0 gpd Plan Date Number of sheets Revision Date Title s. Size of Septic Tank �U�O x Type of S.A.S. Description of Soil 4 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of 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 .o a 0�/ Date Application Approved by r (`n Date-- Application Disapproved by Date for the following reasons rl Permit No. O •U L G Date Issued 3 f/` --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed(U}- Repaired Upgraded( ) Abandoned( !)'byXQS-e ye at J? Mf l r2/O r 4.(,IAoy C—h 41�1-V111 has been constructed in accordance / with the provisions of Title 5 and the for Disposal System Construction Permit No. G/6 '� dated 3 Installer J��f>��� ��l�`Y/OS ` Designer `// J Gy1 S' L lV[ #bedrooms Approved design flow 3-3 U gpd The issuance of this permit shall not be construed as a guarantee that the system will nc'on as desig,ed. Date Inspector 1� ✓ l . ._-- --------------------------------------------------------------------------------------------------------------------------------------- No. .2 U 1 O 0(,0 Fee /U U- THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal .6pstem Construction Permit Permission is hereby granted to Construct(C--)- Repair Upgrade( ) Abandon '(G—)` ( ) System located at I'64��/O (i(/!4 y and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction/must be completed within three years of the date of this permit. Date �L'// Approved by )- MAR/15i2013/TUE ' 1 :45 AM FAX No. P. 001 ' Town of Barnstable •�'"�' � Regulatory Services Richard V.Scali Interim Director • BAAM6RASI.E, � e Public Health Division or ° Thomas Mclean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: �j ke7 Sewage Permit# Assessor's MapTarcel MP73 Designer: � TS Installer: p �— Address: Address: �id//L7yL7�> 03, Lf/� �O J � S was issued a permit to install a (installer) 1J1� septic system at 3 1}'� VfVUA(T W 414. CQ �l VIA based on a design drawn by (address) dated 1 d (designer) I certify that the septic system referenced above was installed substantially according to the design, Which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed, with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State &Local Regulations_ Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct e with the terms of the I1A approval letters(if applicable) 0/11 In-�ft er's Signature) r P_ L/��r vDessigner's Signture) (Affix Designer p Here) PLEASE RE URN 'I`O BAI.2NSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BMLT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC REALTEI DIVISION. THANK YOU. QASep6c\Desiper Certification Form Rev 8-14-13.doc cF t►+e ram, BARNSTABLE, Town of Barnstable 9 MASS. ` t63q. �0 039 a Regulatory Services Thomas F. Geiler,Director Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 MEMORANDUM DATE: December 9,2015 TO: Whom This May Concern FROM: Thomas McKean RE: 325 Patriot Way, Centerville Based upon report received from Debarros Septic Service on 8/20/2015 for 325 Patriot Way, Centerville, leaching facility has failed. The Leaching facility needs to be replaced within 60 days. AcKe ou, an 431A ROS DATE Customer: SlATTIC. Sla1VIC34a g--aC5- - Residential • Commercial • Industrial Address: Post Office Box 97 Marstons Mills, MA 02648 508-428-1087 • FAX 508-428-1490 Phone: h.wb TOLL FREE 888-427-1087 :r... t '- ,. ;_ .,�.t,+- tir y �,�... t,�,,.,- '.,�,� w:1 r ems.- '.- s c?sr4n� 3 z €t s? r +;r a�,w -�e v a n g x? ''FTERMS,s� � � '* ,�M� � M'UNITiPRICEaZW TOTAL < . tom 1000 Gallon Do 1500 Gallon 2000 Gallon 2500 Gallon Other ,J\� Labor Snake Jetting Materials Total 1. Please send copies of your invoice. 2. Order is to be entered in accordance with prices,delivery and specifications shown above. 3. Notify us immediately if you are unable to ship as specified. AUTHORIZED BY f Town of Barnstable P# Department of Regulatory Services �uwerw8u4, Public Health Division Bate 7 � . 039. tee$ 200 Main Street,Hyannis MA 02601 ArfD µl't► i, Date Scheduled d 6 Time Fee Pd. f i . i ,foil Suitability Assessment fop Sewn e Disposal Performed By: DA � ' Witnessed By: t iN ' 0 ', L I LOCATION & GENERAL INFORMATION Location Address*. P' i 1�=1 l.Jyp Owner's Name Address 4 , 3 'dam r VA Assessor's Map/P4rcel: 3 ` I Engineer's Name I"!�' NEW CONSIRUOION REPAIR y1 Telephone# �o s Land Use t rTi �� Slopes(% I 0 �'�w Surface Stones Distances from: ripen Water Body ,z ft Possible Wet'Area� ft Drinking Water Well ft Drainage Way. ft Property Line ft Other ft I SKETCH:(Street name,dimensiodso'f lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) See, �c f s F/I/ All ; i I s " " I I I t i I Parent material(geologic) �atLaT e ✓1"�"�✓�) Depth to Bedrock Depth to Groundwater. Standing Water in Hole: i Weeping from Pit Face Estimated Seasonal,1Iigh Groundwater DtTERMINATION FOR SEASONAL HIGH,WATER TATTLE Method Used: in. Depth to salt tnattles: in. Depth CIbServed standing in obs.hole: I in. Groundwater Adjustment tk Depth to weeping from side of obs.hole: Adj.{actor,, _ Adj.(1roundwaterLevel,,n Index Well# Reading Date: Index Well levdl I PERCOLATION TEST • Date '!�l►u� Observation 1 1 Time at 9" Hole# 1 Time at G" .-..-�----- Depth of Perer[--- 1 03 Time(9"-611) Start Pre-soak Time.@ —1 --- End Pre-soak � Rate Minllnch Site Failed; Additional Testing Needed(Y/N) Site Suitability Assessment: Site Passed X - le Data To Be Completed on Back original:.Public H alth Division Observation Ho -- ***If percolafii0n testis to be condricted within 100' of wetland,you must first notify the Barnstable C44servation Division at least one (1)wedk prior to beginning. . V DEEP OBSERVATION HOLE LOG .Hole#�_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.)' (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel 1 41-i1. 13` � C'L 6 . DEEP OBSERVATION HOLE LOG Hole#_ . Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gra el Iv C Y r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistent %Gravel -------------- DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, ra Flood Insurance Rate Man: Above 500 year flood boundary No_ Yes Within 500 year boundary No " Yes Within 100 year flood boundary No .7 Yes Depth of Naturallv Occurring Pervious Material Does at least four feet of naturally occurring pervi us material exist in all areas observed throughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pe vious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Environ ental Protection and that the above analysis was performed by me consistent with the required t t g, pertis and experience described in 3,10 CMR 15. 1 �/' 1,61l2 1 Signature Date Q:ISEPTICWERCFORM.DOC J _ COMMONWEALTH OF MASSACHUSErTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS 7 DEPARTMENT OF ENVIRONMENTAL PROTECTIOM 07M s�e .- / 93 /�j E5 OFFICIAL INSP IZM-NOT Von v®I.IJN'TAI2Y ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A C1ERT MCATTON Property Address: 3a 5 P��/in C✓a� Owner's Name: i Ina G©k4?9.i _ L\ Owner's Address: Date of Inspection: /oL e+t o 07 �— Name of Inspector: (please print) Al Company Name: ,Eil Vl 0-7—E'G1/ Mailing Address: p e,19A /d 007 _4 C=2 Telephone Number(�vg L CERTIFTCATI®N STATEMENT �Y` I certify that I have personally.inspected the sewage disposal system at this address and that the ` Lion rorted below is true,accurate and complete as of the time of the inspection.The inspection was performed ased on�xtv training and experience in the proper fimction and maintenance of on site sewage disposal systems. am a DEP approved system inspector pursuant to Section 15340 of Title 5(310 CM1215.000). The syste Passes M Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature �' Date: Id o 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. A 4- /dn ¢moo r, Owe Le-A cti* S hot5 fie., /le"r LF � �a So/l�S :h 7���' /jeccls l�ufJ,� Notes and Comments f *,rk ,w A v Atid lkaY� Est S►,1Ce lors* ir,r64--AcI ,tee ADoy ZeAdIni* L-t-// SoVo need 74, 6e Ae,,9 1-c$ ****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. Has ge �/_0007 f_�rW e_.!� eoly Title 5 Inspection Form 6/15/2000 page I Page 2 of 11 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM]INSPECTION FOIE PART A CERTIFICATION(continued) Property Address: Owner: o k"e Date of Inspection: /02 02o v Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A Syst Passes: I have not found any information which indicates that any of the failure criteria described in 310 CUR 15.303 or in 310 CUR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: t/Sy One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,NT,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION,(continued) Property Address:3�� ,�/o 4,,e,,o � G✓ C2,4erx, /'7�— Oo2.b 3.2- Owner• ®✓'1.Q Date of Inspection: 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 CA4R 15303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is writhin 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance *This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTT®N FORM PART A CERTIFICATION(continued) Property Address: -� /,4n4 l.-a Owner: a �� I( "a Date of Inspection: D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for An inspections: Yes No _ ackup 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 logged SAS or cesspool Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or _ �esspool iquid depth in cesspool is less than 6"below invert or available vohnne is less than%day flow ; RRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped y 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. _ [/ portion of a cesspool or privy is within 50 feet of a private water supply well. y Tzy 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 conform bacteria and volatile organic eompounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this forma (Yes/PTo)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: Xes Th fllwing criteria apply to large systems in addition to the criteria above) 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 supplyhe 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 C-MR 15.304_The system owner should contact the appropriate regional office of the De partment. r Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SURSURI+ACE SEWAGE DISPOSAL. SYSTEM INSPECTION IPORM PART B CHECKLIST Property Address: 3o2 Owner: G'o vie S Date of Inspection: /d o10 p Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes NTo Pumping information was provided by the owner,occupant,or Board of Health vWere any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? V 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? t" 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 ba es 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: Ye no I 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(3)(b)] Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: e� Owner: vye Date of Inspection: o O OW CONDITIONS RESIDNTIAL Number fbedro /e, Number of bedrooms(design)--? Number of bedrooms(actual): S !'� p r DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): Number of current residents: O l Does residence have a garbage der es or no):if/O ✓eG�o,^ C,v(9-1 Is laundry on a separate sewage system(yes or no):_ [if yes separate finepectaon required) `SS(I e__1 Laundry system inspected(yes or no): (7 L Seasonal use: (yes or no): /gyp Water meter readings,if available(last 2 years usage(gpd)): '4200.5 9,? p®O a1006— O 9,ov. Sump pump(Yes or no): ,1�� Last date of occupancy: �A COMMERCI/YNIDUSTMAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the ' ction(yes or no)" If yes,volume pumped: gallons--How was quantity pumped determined? Reason for p g: TYP 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) Tight tank _Attach a copy of the DEP approval' Other(describe): Approximate age of all.componeVP installed(i Q v)and source of inforrnation: 6 . Were sewage odors detected when arriving at the site(yes or no):&10 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORS PART C SYSTEM INFORMATION(continued) Property Address: �r ���r�c G✓ 6� w j Owner: 0 e1w f Date of Inspection: .109 // BUILDING SEWER(locate on site plan) . m le �— pJl/ Depth below grade: Z Materials of construction:_cast iron _40 PVC . other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): t d-® If/ SEPTIC TANK: ocate on site plan) Depth below grade: <'L 020 Material of construction:_concrete____metal_fiberglass�oiyethylene —other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Id,— ,� Distance from top of sludge to bottom of outlet tee or baffle: �0 Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottor of ud t)tee or baffle: 3 How were dimensions determined: ovro r'i Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels asPrated to` fief invest e�dV"A ffle ,etc.): �� , /•j ' w �K GREASE TRAP:60cate on site plan) Depth below grade:— 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): Page 8 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 4-vea Owner: o ✓`w Date of Inspection: /a- oar 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(expIain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): 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.): PUMP CHAMBER: /V (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.): ` I Page 9 of I 1 OFFICIAL, INSPECTION FORM—NOT FOR VOLUNTARY ASSE SSMTNTS SUBSURFACE SEWAGE DISPOSAL SYSTEM 1<NSPEC7I0N V®RM PART C SYSTEM INFORMATION(continued) Property Address: e ln/ Owner: G-o✓tee j Date of Inspection: Ao p SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Typ leaching pits,number: leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc. : f4 lov-1 (Vle--, CESSPOOLS: (cesspool must be pumped as part of inspection)(Iocate 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 or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation;etc.): PRIVY:k(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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL, SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: �7'✓✓Z.o� G✓� e /LI Od Owner v`1.e Date of Inspection: ld-IA-0162 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building_ Ee 1 �o /tom tf e✓' ,t3 Q3 A? Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENT'S SUBSURFACE SEWAGE DISPOSAL. SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: Date of Inspection: 6 SITE EXAM Slope _ Surface water 7 Check cellar // 0 Shallow wells Estimated depth to ground water 33.E feet Please indicate(check)all methods used to determine the high ground water elevation_ Obtained from system design plans on record-If checked,date of design plan reviewed: erved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: a S Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must descri e ho you established the gro nd wate elevation: e, 01 .� ' Town of Barnstable �p IME fpk Regulatory Services BARNSTABLE ; Thomas F. Geiler, Director Muss. 9g, 1639. ��� Public Health .Division Thomas McKean,Director 200 Main Street, Hyannis;MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. yST. CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28•Centerville, MA 02632-3117 1926 1 508-790-2375 x1 • FAX: 508-790-2385 John M.Farrington,Chief Martin O'L. MacNeely, Fire Prevention Officer Craig E.Whiteley,Deputy Chief Francis M. Pulsifer, Fire Prevention Officer February 27, 2006 Mr. Thomas Perry Town of Barnstable- Building Commissioner 200 Main Street Hyannis, MA 02601 Dear Commissioner Perry: Pursuant to MGL Chapter 148, Section 28A, I am making you aware of and request your interpretation of a suspected un-permitted basement apartment with egress issues at: 325 Patriot Way j Centerville, MA 02632 A I During a recent inspection at this address, I observed separate living quarters in the basement of this address with a full kitchen,bath and bedroom. In the basement area, there was inadequate smoke detection and inadequate egress. The entire residence including both floors has a total of five rooms being used as bedrooms; the Town of Barnstable has this property listed as a three-bedroom dwelling. Please feel free to call me with any questions relative to this situation at 508-790- 2375. I am holding the 26F smoke detector.certificate until a conclusion can be determined from your office. Thank you for your prompt attention to this issue. Sincerely, Francis M. Pulsifer �i Fire Prevention Officer st: Cc: J. Fitzgerald- Local Building Inspector ' R. Giangregorio- Zoning Department T. McKean- Health Department /W a o(O 3/��� "Commitment to Our Community" a . COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION �AP 9 3 OARCEL, ' 193 193 —�51 TITLE 5 , OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS�SSM ikJ)PS ED SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A i NO V 2 9 2004 CERTIFICATION TDVV OF BARNS TABLE Property Address: G1�/�l'n �- t✓�� HEALTH DEPT erv� e d(1.1.. Owner's Name: x4on" Owner's Address: (f,-ovL Q(ro� Date of Inspection: �y� Name of Inspector: lease print) / � w4- a Company Name: A/r/ t0i — TEG Mailing Address: P0 Telephone Number: 0 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: V Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: /" Date: The system inspector shall sub 't a copy of this inspection report to the Approving Authority DEP)within 30 days of completing this' d(Board of Health or P g inspection If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. ` Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 3a Owner: SjL Date of Inspection: Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. Sy Passes: I h have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. Sy em Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y N ND)in the for the following statements.If"not determined, 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 existing tank is replaced with a complyinginspectionse c tank as approved by the Board of Health. pass inspection if the *A metal septic tank will pass if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broke approval of Board of Health): n or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: L Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: ✓� �����o Wci Owner. G,, Date of Inspection: // C. rther Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: — Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. — The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: Bh f✓I lie/ 0i-� Owner: Date of inspection: / 0 D. System Failure Criteria applicable to all systems: You must indicate`yes"or"no"to each of the following for all inspections; Yes No� — Xaackup 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 Zflogged SAS or cesspool S c liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or Gsspool quid depth in cesspool is less than 6"below invert or available volume is less than%day flow pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped �Y portion of the SAS,cesspool or privy is below high ground water elevation. portion of cesspool or privy is within 100 feet of a surface water su 1 or tribe ater supply. 1?p Y tary to a surface 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 coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Y', he system is within 400 feet of a surface drinldng water supply e system is within 200 feet of a tributary to a surface drinking water supply e system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped one H of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant "yes"in Section D above the large system has failed.The owner or operator of any lare system consiber�aered significant threat under Section E or failed under Section D shall upgrade the system in accordance with ed CMR 15.304. The system owner should contact the appropriate regional office t the Department. I Page 5 of l l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B r CHECKLIST Property Ad ��i dress: J�J +/i 0 (,�a Owner: r Date of Inspection: Check if the following have been done.You must indicate` es"or"no"as to each of the following: Yes/Vo g information was provided by the owner,occupant,or Board of Health _ — W any of the system components pumped out in the previous two weeks e stem sy received normal flows in the previous two week period HaX&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 7of the r tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems , The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no xistmg 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 cceptable) p10 CMR 15.302(3)(b)] Page 6•of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 22 SYSTEM INFORMATION Property Address: —1 c►�,o � (n/a ✓► �/i t' Owner: Date of Inspection• / FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): ,3 Number of bedrooms(actual): DESIGN flow based on 310 Cj 15.203(for example: 110 gpd x#E of bedrooms): Number of current residents: (J Does residence have a garbage grinder(yes or no): zkv Is laundry on a separate sewage system(yes or no):;V Laundry system inspected(yes or no): [if yes separateinspection required] Seasonal use: (yes or no): �1 Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):,(�0 Last date of occupancy: COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CUR 15.203): 2pd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):— Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INF RMATION 11 Source of information: )40T 10`^j-ei '.5 f" ��,J plN,•tP.,� Was system pumped as part of the inspection(yes or no):- If yes,volume pumped:_______galls—How was quantity pumped determined? Reason for pumping: OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy —Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Altemative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all component,, to installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): } Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner._ _ Date of Inspection• $1/1 BUILDING SEWER(locate on site plan) l Depth below grade: /j / Materials of construction: iron VC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc,): SEPTIC T (/TANK.-_,(locate on site plan) Depth below Material of construction:—/concrete metal__fiberglass 1 eth 1 _other(explain) --lm Y y ene If tank is metal list age:_ ',s age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) t./ / Dimensions: �C Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: a� Scum thickness: i Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to botto f outlet tee or ba$l�e: v How were dimensions determined: 7'0� /Co► �� Comments(on pumping recommendations,inlet and utlet tee or baffle condition,structural integrity,liquid levels ash elated to outlet imr evi�of leakage etc.):etc.): �// GREASE TRAP:&q/ocate on site plan) Depth below grade:— 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(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, as related to outlet invert,evidence of leakage,etc.): liquid levels Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 3a i1a 4fl o l Owner: Goa f Date of Inspection: / p TIGHT or HOLDING TANK: 't/ (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass__polyethylene oth er(explain): Dimensions: Capacity: altons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: 41,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.): PUMP CHAMBER:&(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 appurtenance etc.): Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C /� SYSTEM INFORMATION(continued) Property Address: 3olJ j 6,4n a- Owner. Date of Inspection• p SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type Cc's 4-- leaching pits,number: leaching chambers,number: w/I s �-o r!� 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.): r444 rc CESSPOOLS:A (cesspool must be pumped as part of' on mspecti X loca to 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PAY: (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.): a . Page 10 of 1 i OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ads Owner: C i 4 Date of Inspection: i Q SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referenda landmarks or benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building � d DeCV" O Ile 4S919 ' /�3- ' c Page 11 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address. -�' /rt�✓ �✓� Owner: Ce,�_. Date of Inspection: f SITE EXAM Slope Surface water Check cellar Shallow wells 3 �— Estimated depth to ground water 3-dfeet 3S Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-U checked,date of design plan reviewed: e`rved site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: YM G n Checked with local excavators,installers-(attach docnmehtation) Accessed USGS database-explain: You must desre w you established the h�ground water ele at�a: 7 OF !fo M v--ff-- dC"t- 9• 7..e/ow ice, de- •02 f f ,J A yPe— , • p� S 'B�Prot �o y 17 c0 0 i t 0 0 n �/ c� p 0 0 0 X / ' / SHE t�ti Town of Barnstable k • IIARNS-rA6LE, MASS.39- Regulatory Services Department i679• AlFO MAC a, Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 14, 2007 Dilma Gomes 132 Buckwood Drive Hyannis, MA 02601 Dear Ms. Gomes, NOTICE TO ABATE VIOLATIONS OF CHAPTER$353 —NUISANCES - OF THE TOWN OF BARNSTABLE CODE. The Town of Barnstable Public Health Division Office received a complaint regarding your property located at 325 Patriot Way, Centerville. On February 13, 2007, Thomas McKean, Health Agent for the Town of Barnstable observed several bags of refuse, uncovered, some torn open on the ground, a violation of Section 353-1 of the Town of Barnstable Code. You are ordered to remove all refuse from the property within twenty-four hours of your receipt of this order letter. Failure to comply with an order of the Agent of the Board of Health may result in a non-criminal penalty of$40.00. Each day's failure to comply shall constitute a separate offense. Sincerely, Thomas A. McKean Director of Public Health q:\boh complaint Itrs\325 patriot way.doc Certified Mail#7006 0810 0000 3524 8400 w IKE r°may Town of Barnstable BARNSTABLE. 9$ " 39- 163q. Regulatory Services Department ArEb MA'S A, Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 12, 2007 TAT;.,^ta�... D)I MeA ' u erry SMt 1'32 rAA Dear M , (1tSLPublic 2— The Town of Barnstableealth Divi on Office received a complaint regarding your property located at Hyannis. The al e being p1ht,;ct, ,,,, thA fr&H lawn.1 1 i^tag M 04-11 r �L On February IV, 2007, T-i*iet Health for for the Town of Barnstable knocked at t the lbeif a n yar operties, k� U.Ir-evM den rLo m,,,,hPr�Lrnnmc leas ecti n of the i ng. Yoe Ck r+1 . rzM Wcerely, c f L '�f -at edr-4 C,r 1}E as t� 1 �i..�. ��� eA t 0A —C-C'k"f'dj Thomas A. McKean Director of Public Health t-a -�:i(7 �� '73d5-;R—I q:\boh complaint ltrs\63 mulberry street.doc Certified Mail#7006 0810 0000 3524 8325 `�_ Health Complaints 15-Sep-06 Time: 3:20:00 PM Date: 3/8/2006 Complaint Number: 18681 Referred To: DONNA MIORANDI Taken By: ELLEN WADLINGTON Complaint Type: CHAPTER II HOUSING Article X Detail: ILLEGAL OPERATIONS Business Name: Number: 325 Street: PATRIOT WAY Village: CENTERVILLE Assessors Map_Parcel: determination. Investigation Date: Investigation Time: 1 5 f � r2- LWIl f�• `,Nr ..'...eeno..armas..c ..«vu..n:u.>.v�^`''u - v.aranr :�..'n^'.`.rurmaxve�.r a�um.uam+x:./' ---------- i L � L 5 -77 b oo 55 _ y Qom." � PIa c.d "INV. 5 0 L IS . E � �4S r � _ —.� r 1��I_-Ee(�(_S��GI�_�111C/ J=vluL/.� _�uG(Q;—��(-C-/✓..l_�r_L G��LI_�. / J kl ' Cif �/`��.�'Lw-��tiP_►^(�.V(�:��'`I_� TUrr���T fly--Q--��'_'c�,�GGrr��Gl��. �.r_Gr-1-�G�.!✓i/�.��✓_ ✓�e��N�✓�U�-� -a 7°C cn�:�q 1 4-k,_�.-th,P f 1. n � l � y/ l � . . _ I.✓—('i_V�:V� —�'��_l_. ,�\��I/u �-o'� _h ,..,✓��'e_cr_JL _G'`✓>_i�c�- — .. J � I t c c . r ( , +. '"' dw'c., ' (,JC, - tJ LWC'AT �ON / � 'l°(3l��SEWA E PERMIT JNO. OWL VILL=A&E I VS T A.L L E.R'S NAIVE 1 ADDRESS -7Z It1t-LDE OR. 0 NEB ,DATE/ PERMIT 1S ,SUED 1?- -- Z'? HATE CQMPLI A NCE ISSUED � ,� +im •��` fmfi (S t . I ri No......... ............. FE$...,lV................... L THE COMMONWEALTH OF MASSACHUSETTS W T Bode RD 0 �-1 E 'U / 32 ......OF.......... . ............: ApplirFa#iou for UiipuuFal 1vorks oustrnrtiun Famit OI3 0 Application.is hereby made for a Permit to Construct ( or Repair ( ) an Individual Sewage Disposal System at: _ _ ......... t. ... 1" < i. 1 - 7..................................... I Loca Add re ,r-- or Lot No. Owner Address --------------- --- -------------- a Installerddress (� Type of Buildi �«-� Size Lot.14/6R.0.......Sq. feet Dwelling No. of Bedrooms.......... __________________________Expansion Attic (JJ'O Garbage Grinder ((ice Other—Type T e of Building ___t_®�_a_______. No. of ersons__yp g _ p __________________ Showers Cafeteria ( ) a' Other fixtures -------•__________________________ W Design Flow..........,' _& ....................gallons per person per day. Total daily flow....f. .........................gallons. WSeptic Tank—Liquid*capacity/®;!5_.gallons Lefigthf�.4j._.._.. Width.!I�,,.A�_.__.. Diameter___- Depth...4.1...... x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... k_'e— Diameter----rp... Depth below i et...4P E1'-.. Total leaching area../Q�e....sq. ft. Z Other Distribution box ( ) Dosing to ( ) --j y -�G — Percolation Test Results Performed by._,e��J`°f �.. , .........__....•.................... Date....//).'! ...-� . Test Pit No. 1...�_Y..minutes per inch Depth of Tes Pit.................... pth to ground water--_-_-_______•__---_-__. G4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ W' •• . -- -- ....... --- . Descriptio Soi....n••--0._—X: ._ . ...�. '. .a..:`...2 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 THTL 11 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the 40ar of health. igned 't... . ........... � . /ZIS Date Application Approved B - Date Application Disapproved for the following reasons---------------------•--•------------•--------------------------------------------------------------------------- ••------------------------------------------------------------------------•------.......------------•-•--..-------------•---------------.._._..._.......------------------------------------------....... _ --:--•--Date Permit No......................................................... Issued_-- �` ...... Date r ,No.. ... ... '.. •_ ti- Fps ,�✓ . ' \ THE COMMONW)Ei4LTH OF MASSACHUSETTS BOARD OW HE . . • `-- .'�- OF...... ..................... , lirtt i�an forDisposal' nds nnutrtirtiun ernti# Applicaiiori is hereby made'for a Permit to Construct (f_ or Repair ( )'an Individual Sewage Disposal system ate .... --- �, Locat Add s+ ,.r�^ or Lot No. �` ,;,,k6 .... f n YZ. -- . ... Al i Owner ! Address �' - - ----- _d _. 4.P 1. '.C�:-� . r"c �.y s G� l Installer Address �,./ Q Type of Build Size Lot./_�'?/ _-Sq. feet Dwelling No. of Bedrooms____. ............................Expansio Attic (�/c� Garbage Grinder Other—Type e of Buildin ® p, yp g ... :-- .. No, of persons. . ................... Showers (A4 — Cafeteria Other xtu es -----•------•---••-•..................•-•• ---------------- ---.......- ••- Desi Flow..-...... ... allons per person per day. Total daily flow-__- - .�. ......................gallons. W 1rn ---•---•--- --•--g P P P Y• Y � --- WSeptic Tank—L"iquid capacity/�a�' •gallons Lengthf.f f_._•_''Width_ � ......... Diameter-4-4_... Depth...4_�..... x Disposal Trench No............ . .... Width.._ _.. Total^Length.....:... Total leaching area....................sq. ft. Seepage Pit No ._ +_` _._ Diameter ..(0...Fr'._- Depth below inlet .(e. Total leaching area.. °.e...sq. ft. Z Other Qistribution box ( ) Dosing to Percolation Test Results Perf rmed by_ c�.,. f. ...................:. Date____ "°«" P P Depth-to ground water'..-.-.................... Test Pit No. 1...4 0.0...minutes per inch De t of Test Pit ....- Li, `Test Pit No 2...... ........minutes per inch Depth of Test Pit.......-........__.. Depth to ground water........................ O : Descriptio i So -` ." :* J/ � ��.// W ... ......................................' -_..._.._...;..._ Y._.._.� _ ------------------------ .0 Nature•of Repairs or Alterations=Answer when applicable........ 4 ---••-•• ---•--• .... ....... .................................. -• -- .................. Agreement �� w The undersigned agrees to install the aforedescribed Individual Sewage--isgosalASystem iri accordance with the-provisions of ITLL 5 of the State SanitaryCode The undersigned further agrees not to lace the.system in P g g P Y operation until.a Certificate of Compliance has been issued by the ar of health., igned � d1.- . Date/ A'"t iication-A roved-B Date Application"Disapproved for the following reasons:_ :.-.- f___.-_ --------------- --•-•- ..................................... .......••____.---_---•--.-----....-_------.... _.............. - ------------------------------- -_--- - Date Permit No.................. ---_....-=........... Date ....-•-----•--- THE COMMONWEALTH OF MASSACHUSETTS 1' BOARD F HEA ,. ,ter{ •'"{ Ky"1 �.. ......OF. ... '?0.'[�r . .F..................... wrtifirtttte of Touts haur�e THIS IS O' ERT Y That the d n�al ewa Dis satem str d ( ) or Repa>red ( ) Ins ------------- at._.� rr. .............................................. has been i alled in accordance wi�ii the provisions of T ` of The State Sanitary Code as described in the application for Disposal.Works Construction Permit No: _...44 ............ dated::.AAO^"'/_Al------ �_-.---- THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS'A GUARANTEE THAT THE SYSTEM 1dVILL FUNCTION SATISFACTORY: DATE...........I[........ -....... .............................. Inspector...... _ i /t• - -----------------•-----_----_-_--.-- THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH : . ,j Q <d^�"t ..........OF...... � �' ... ............. ....... ...... NO.......................... FEE..... /...Y ......... Disposal ur, ii , din �eriiti# Permission i . reby granted .: = C . .--•---• a...._. to Con t or pair-( )fri du 1 ewa Di 'al y r at No.�� -- Street as shown on the application for Disposal Works Constructi n. Permit No..................... Dated..W_?t w711.....-. Board'of Health` DATE............................-------------•--•-- FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS rL�II-�( FLOW � ti0 +c 3 t 33U G•P•t�; . /,�`� �<=P�IC TAti1IC = 3�O,r 150 a!e A-9 5 G.P.D. �--' USA: 1 bOh 64,L. r� / SPOS,&L PIT - L-)SE. It>OC, GAL. �'! 43 SUeWALL AZE.A = tso s.F. �3� i�jo SF. �c 2.s • �1S G.P.D. � �" �,;� 73crr-rOAA AQUA= C�;O SI=-. \ 15D o = 5o c�.RD. 3� Z*7 %\ TOTAL 'L;>ESIGIJ = 4SS �. T'oTQL- DA.IL-.-( FL.0VL/ = 3-2 PT-=2GDLQT1OQ Z&TE IQ 2-A.410 02 Lr✓SS. FvUuD t � S r e A $per (V \Q IV u�L►Xt.B r �� 4 WILLIAA7 Ito. 19334 O Ir ItQ/3TE,"It, pQ' TO'P �iJt3 LIbO.C. 771 S'd 'JiG 4 aVPST. Iw. <>AL. :. -Box 93.5 Gepnc I o -2 ,aQt)57-YZ� luv. TA�tK ew4u loop °1�,0 GAL. q 3•� q3.3 T -S CC l4i/ W�r� l�,/UT�r 2 Ar `l0.5N� STON{= B.S U �' � I I CEQTtFIEL� pL.cST 1<L.1�1•.1 art -t� u o sG p,L�- �c fit_k;! As. bA.T C— I D• ��J7 AUq 76te cGixTIF-1 -r 4AT T{-1r-- PODUDAT16Q 5"o dQ o vfaAA LIeG W ITI,: - I-AG �toc_�I►-�� t_.oT �1 AWZ:> SETLlACIG 'c[�utQEticL_�T� oI= -rNc:. TOWIJ of LSt�P.�S-r1� L.C. 12,A7:TC-=}Z. • REGtS`T'C_lZ�..D L.�I••!G itJe.v'�.Yol�s � '•('1-315 l7 LAI-•t (4y 1..dOT t'„C�r�CC� Ua`..► Aal oSTEt�v�I,.LC_ o Ilr{AS��. I, il.iSc J�.�cw T �,vc_.�LrY TltcY oFr_,GT-�, �I towt.z� APPL.t GA,I-J-r ��I 1.1 1�� t� ►�L� C.c-•_ v,ea to -- , ^ � CENTERVILLE LEGEND oPK S�EE� LOCUS 325 PROPOSED CONTOUR PATRIOT WAY 79 /O ® PROPOSED SPOT GRADE D �1\ -- gg -- EXISTING CONTOUR D-+ �� \\ + 96.52 EXISTING SPOT GRADE o W— EXISTING WATER SERVICE � I \I TEST PIT STq I \.� -76 \ \ \ LOCUS MAP 1-74 \ STONE DRIVEWAY LOCUS INFORMATION L \ BENCH MARK TITLE REF: CERT. 185697 L ��\ \ , _\ O PARCEL ID: MAP 193 PAR. 173 TOP OF DRAIN GRATE ® 71 .58 BARNSTABLE GIS DATU SEPTIC SYSTEM C� 00 1 I z o REPAIR PLAN I � z- Z Z J LOCATED AT: �° �o� � EXIST. I ,000 GAL 325 PATRIOT WAY C1 / �a Q ri \ SEPTIC TANK 20 f�� ,� CENTERVILLE, MA / N PREPARED FOR HUNTER �4. / OCTOBER 12, 2015 I \\ I o �\ I qs OF _ 0 j \\ �/ o DARREN M. / 12 70 Mi Q N ! I --1 i N0 LL C L C`�T 5 ! ,2,6 0 n -AREA \- 16177 sf+ / / � �p G/SfE LAND COURT PLAN 38507—B ,/ / // v,�nt ' ASSR MA�193 PCL 173 �� �' ,� ' �� ' 40 ml POLY LINER (see note 16) MEYER & SONS INC. `- '' P. O. Box 981 7T� !' i E. SANDWICH, MA 02537 �0 °p - i ' PH. (508)360-3311 EXIST. 1 ,000 PIT 74 72 70 fax (774)413-9468 (see Note 10) meyerandsonstitle5@gmail.com www.meyerandsons.com � SCALE 1"=20' SHEET 1 OF 2 J 1491 i i ELEV. TOP . FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (76.0) MAX = 80.15 �F.G.EL: 78.0 F.G.EL: 77.15 F.G. EL: 76.0 i VENT MAINTAIN 2% MIN SLOPE OVER LEACHING AREA A :Y 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" F.G.E.: 76.30 PLACE SANITARY •'• STONE OR FILTER FABRIC DOUBLE WASHED STONE :A V. 6 TEE IN D-BOX4" SCH 40 PVC ,7, 14 6 Q S= 1 ®®®® O E3E3 A: TEE'S ARE TO BE (MIOF. ®®®®®®®®®®® INV.72.70 ®®®®®®®®®®® 4" SCH 40 PVC 2 DEPTH ®®®®®®®®®®® INV.75.0 INV.72.50 GAS _ 4' 2 X 8.5' 4' PROPOSED DB 3 EFFECTIVE LENGTH = 25' EXISTING OUTLET BAFFLE :...•. ., DISTRIBUTION BOX INV. 75.25 (H20) INV. ELEV.= 69.50 EXISTING 1,000 GALLON SEPTIC TANK GAS BAFFLE TO BE INSTALLED ON P��� �F Mgss9 BREAKOUT OUTLET TEE AS MANUFACTURED BY TUF-TITE, ZABEL, OR EQUAL i DAME' R �^ TOP CONC. ELEV.= 70.50 ELEV.= 70.50 W5' 5 NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING No. 1 0 INV. ELEV.= 69.50 PIPE INVERTS PRIOR TO CONSTRUCTIONI®lid®® .2) D-BOX SHALL BE SET LEVEL AND TRUE TO qE�/$T�r<y 13 ®®®®GRADE ON A MECHANICALLY COMPACTED SIXNITAR�a� BOTTOM EL.- 67.5 ®®®®INCH CRUSHED STONE BASE, AS SPECIFIED IN n , 3. FT. 3.75' 310 CMR 15.2ING 1 EFFECTIVE WIDTH = 12.5' 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK SEPARATION 5.00 FT. WITH GALLON SEPTIC TANK IF FAILED, SEPTIC SYSTEM PROFILE DAMAGEDED,, NOT H2O LOADING, OR UNDERSIZED. SOIL ABSORPTION SYSTEM SECTION 4) INSTALL INLET & OUTLET TEES W/ BOTTOM OF TESTHOLE EL: 62.50 (SECTION) GAS BAFFLE AS REQUIRED (500 GALLON H2O LEACH CHAMBER) GENERAL NOTES: SOIL LOGS DESIGN CRITERIA I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL P : 14854 NUMBER OF BEDROOMS: 3 BEDROOOM BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: OCTOBER 6, 2015 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #1614 - 310 CMR 15.405 (1) (B): DAILY FLOW: 110 G.P.D. X 3 BR = DESIGN FLOW: 330 G.P.D. 1) A UP TP 3.0 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING WITNESS: DAVID STANTON, BARNSTABLE B.O.H. TO BE UP TO 6.0 FT (MAX) BELOW GRADE VS REO'o 3 FT. (H2o/VENr PROVIDED) GARBAGE GRINDER: NO (not designed for garbage grinder) 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR SEPTIC TANK: 330 gpd x 200% = 660 gpd, USE EXISTING 1,000 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE Elev. TP-1 Depth Elev. TP-2 Depth DESIGN ENGINEER. 73.50 A 0" 74.0 A 0" (330) = 445.94 S.F. 4 FROM CONDITION HOSE SHOWN OUN E RED DURIN SHALLBE ONS RUCD O0 IF DING ESIGN Y LOA SAND ; LOAMY SAND LEACHING AREA REQUIRED: ENGINEER BEFORE CONSTRUCTION CONTINUES. 72.68 YR 3/2 10" I 72 68 10YR 3/2 t 2" 74 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. B LOAMY SAND tOYR 6/8 70 1s B LOAMY SA 46"D USE TWO (2) 500 GALLON H2O PRECAST LEACH CHAMBERS W/ 4'� 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 69.50 48" STONE ON ENDS & 3.75 STONE ON SIDES: 25 L X 12.5 W X 2 D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF C C HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PERC O EL. 68.1 FINE SAND FINE SAND BOTTOM AREA: 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 67.32 2.5Y 7/4 74" 2.5Y 7/4 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED 67.67 76" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF To A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. C2 C2 TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING FINE SAND FINE SAND DESIGN FLOW PROVIDED: 0.74(462 S.F.) = 342.25 G.P.D. vs. 330 G.P.D. req'd } CONSTRUCTION. 2.5Y 7/2 I 2.5Y 7/2 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE 5. PROPOSED SEPTIC SYSTEM UPGRADE PLAN HOUR NOTICE FOR 12. THIS PLAN IS TO BE USED IFOR RSEPTIC SYSTEM PURPOSES ONLY CERTIFICATION 62.50 132" 63.0 132" 325 PATRIOTS WAY, CENTEVILLE, MA AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY PERC RATE <2 MIN/IN. (*Cl' HORIZON) Prepared for: Hunter 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. NO GROUNDWATER OBSERVED 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. Engineering and Survey by: SCALE DRAWN 15. ALL PIPING TO BE 4" SCH 40 ® 1/8'/ ( )FT UNLESS SPECIFIED . 1. Darren M. Meyer, R.S., CSE, hereby certify that I am`currently approved by MADEP pursuant to 310 CMR 15.017 MEYER&SONS,INC. N.T.S. DMM 16. PLACE 40 ml POLY LINER AS SHOWN, FROM ELEV. 70.50-66.50 to conduct soil evaluations and that the above analysis has been performed by me consistent with the PO BOX9Bf TO PREVENT BREAKOUT. requirements of 310 CMR 15.017. 1 further certify that I have passed the Sol Eval. Exam in October, 1999. E41STSANDWICH,M402537 DATE CHECKED SHEET NO. !_ 508-8B2-2922 10/12/15 DMM 2 of 2