Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0014 PENA WAY - Health
14 Pena Way Centerville jI A = 246 199 H Omtr' ; or, Jd NO. 1521/3 ORA Bpi_' AMMMA TOWN OF BARNSTABLE LOCATION { Lf POEAJ14 W&J SEWAGE# ;tO 15 40 VILLAGE CCNTEAW(LL6 ASSESSOR'S MAP&PARCEL I INSTALLER'S NAME&PHONE NoQo4PGtdtD6 CO-L-X-QeJ.St3 407.1 88-17 SEPTIC TANK CAPACITY 10 0 0 G--W L--01d LEACHING FACILITY:(type) 604eeocV-� (size) It NO.OF BEDROOMS Gy;5-r(f.XX ®7, (330 GPO OWNER CTAWEAL) PERMIT DATE: 3 -6 l COMPLIANCE DATE: 3— Separation Distance Between the: N® C-ZQD00Dwct'aR Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility q►)tP+Jr&-,C:, Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) MIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within �,g 300 feet of leaching facility) /q{ A Feet FURNISHED BY CA p E a 8p ig E RXP4 eS A-1 j2ao1° S-i a 231 !=2-s' B-z A is' x Q-3 _M(-' A 33 L° A 13 a Fier TOWN OF BARNSTABLE SEWAGE # L,-t�sA� -`�ASSESSOR'S MAP &LOT =Lq3 1. AME&PHONE NO. �!b I)e-A-S SEPTIC TANK CAPACITY O ` LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER j PERMIT DATE: c 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 0 Pf 3— 1-1 133-Cn3 No._��✓/ `' — © Fee 16`® THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes fiprication for ]Disposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair()� Upgrade( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 14 P W4 U_)AY d 401fL� Owner's Name,Address,and Tel.No. EDc AP-b c;T�w4 Tl�`( Ci�Al2lJ i1�111 Assessor's Map/Parcel UJ < 6 i S Installer's Name,Address,and Tel.No.5 pg-qy7-gS71 Designer's Name,Address,and Tel.No. 6APSUX-b-15 C/(>C. Eu 6�ll,d ca oMr.S Te.kl W 0A<0 Type of Building: Dwelling No.of Bedrooms Lot Size �T�( , j 1 sq.ff. Garbage Grinder( ) Other Type of Building IRES(DIEW 4 A L No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) N 1?aR-1lrLZ 4pd Design flow provided 3 9 1. 2, gpd Plan Date 3 a• 02 O 1 Number of sheets Revision Date Title 1 LI P ewA WAY Q m.lEWLLG. Size of Septic Tank I an ro G Type of S.A.S. Description of Soil Q. r' *RL J `P T7W Nature of Repairs or Alterations(Answer when applicable) JS d Gx l.TT l Q& tools car4-ELw s eyyk . -OWL., Wag g c�` or s m&� g 5 u b2iza "[ J 0" 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. igned Date Application Approved by Date �D J Application Disapproved by Date for the following reasons - Permit No. CJ —� �� Date Issued J No. s. THE COMMONWEALTH OF MASSACHUSETTS Entered incomputer: I Yes PUBLIC HEALTH DIVISION - TOWN OF,BARNSTABLE, MASSACHUSETTS appYitation for is osaY fps rn Coristruttion Permit Application for a Permit to Construct( ) Repair(Y� Upgrade( ) Abandon( ) 'XComplete System ❑Individual Components Location Address or Lot No. 14 P60v4 WA-( C I v 4LE Owner's Name,Address,and Tel.No. C-rXulA" < T!wt 0-rr"- Assessor's Map/Parcel 14 PeVk WA:1 <3tF1J1t3%V1 _C_ Installer's Name,Address,and Tel.No. 5 Qq-K77`BS-n Designer's Name,Address,and Tel.No. 4AP67,0(b6i C.K. (A..)OAX-S ' &<, J I S I Gu" u t-w_a r AE'i- 11_ W esx c4zoss p r rw RP FvA..E T C>*-L, Type of Building: Dwelling No.of Bedrooms Lot Size 1 1 5! sq.ft. Garbage Grinder( ) Other Type of Building JZIC-S .4C_ No.of Persons Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) ;3 3(] UkNJ PrR lour V.�pd Design flow provided 3� (/ � gpd � Plan Date .3 -A ' A o i1 Number of sheets Revision Date Title 1 y P cN/4 WAY e l✓ rus-5" Size of Septic Tank U O y Type of S.A.S. G L6_*4 b110(x Description of Soil . S A AJ p *oL Sq Tl-7#/ 5t-,2�- P CA m Nature of Repairs or Alterations(Answer when applicable) U,5 G (M IS(t 1Jf,7G j {,(,�J 5 ��(r 'Cic1.� T to 0A.) ki-XO 'D-00\C -M S C.G. G GC- (06L l9U StMST W(Zbk q, 0;:7 S ZUA.45 S v PLCLWL'4b r 4LJ C w. 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 3 " -4 0P5 _ Application Approved by Date Application Disapproved by Date for the following reasons f :y Permit No. ey Date Issued 3 - ----------------------------------- --------1. - - - _. m' THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliante THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( ) Abandoned( )by CA, D�0e>G G� JQJS'65 LLB,. at 4 P ie m A WAN Cow<LLA5 has been constructed in accordance 3/ / with the provisions of Title 5 and the for Disposal System Construction Permit Nevi-5 0 c'�dated 6 5 Installer- Cal &A;r)6 C../.. Designer 1E tJGCI Nt 944LX r wogu<c .=t,J<_ #bedrooms Approved design-Row -9 3 0 (0 1W T 11 a gpd The issuance oft is ermi,t hall n t be construed as a guarantee that the system wi de i ed. Date Inspector &V 0 X23 / _ I ` V ------------------------------------ --------------------------------------------------------------------------------------------- No. �/ r5 U y� Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(X) Upgrade( ) Abandon( ) System located at 0 PI5:6)A- wA\1 CEx)'reAy((,u 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. i i Provided:Construction must be l o9leted within three years of the date of this permit. Date > Approved by Town of Barnstable 4P�0?T E?Oay'Y Re.guiatory Services Richard V. Scali, Interim Director BAR' SS.ABA' Public Health Division Thomas McKean, Director 200 Main Street;Hyannis, NIA 02601 Office: 5 8-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form „ s� a 01 S -0 ff0 Assessor's Map�P arcel Z 4 (a—I q Date: i Sewage Permit# De igne --=�:�,-����sn'5 W:L',- �1r—�=, Installer; Cam, w�`ck oC�C�s-2f Addres : 4 2 �.��c�,s - Gvmss2t e �c� ( Address: 15 �v`�t�'�•C<zs��t� S�— On_3 } �e�''� ���� was issued a permit to install a (date) �f (installer) septic s stem at l �"`� ��^K 6evikVV AC based on a design drawn by address) 2-� r rL 5 dated <31 2 i (designer) certify that the septic system referenced above was installed substantially according to e 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. certify that the septic system referenced above was installed with major changes (i.e. eater than 10' lateral relocation of the SAS or any vertical relocation of any component f the septic system) but in accordance with State & Local Regulations. Plan revision or ertified as-built by designer to follow. Strip out (if required) was inspected and the soils ere found satisfactory. certify that the system referenced above was constru � OF with the terms of he IAA approval letters (if applicable) PETER T. o McEN TEE No.3510�1 h i. °0 ( taller's Si' tore) LL �IONA Signature) (Ax Designers Stamp Here) (�4)esigner's (Affix PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORA/1 AND AS- E—U-1L7ICARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. T YOU. Q:\Septic esiper Certification Form Rev 8-14-13.doc Town of Barnstable P# —/ Department of Regulatory Services ,►ttr,�ru3� s Public Health Division Date MASS. t439 �� 200 Main Street,Hyannis MA 02601 Date Scheduled ��, • _ ,••Time Fee Pd. Soil Suitability Assessment for Sen Dzs OPetro y; E �-F.r f l( �I l l � (� ! �{ Witnessed By: LOCATION& GENERAL INFORMATION Location Address - —t3wner's Narrte—" . /� ,,—A!l Address I L— t)LxJ0! (ILIA-4 et L j'l LLC= Assessor's Map/Parcel: Engineer's Name S NEW CONSTRUCTION REPAIR X Telephone# Land Use I — `> &LL.-y } u Slopes(90) t Surface Stones CV U P y : .0 i Distances from: Open Water Bod = ft Possible Wet Area /t' (� ft Drinking Water Well'>> ft Drainage Way / �' ft Property Line ._1:?f7 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands in prox imity trruty to holes) i ,lu.1•i ON Parente material(geologic) �G�'`��5�� Depth to Bedrock /`'I 1PA i Depth to Groundwater. Standing Water in Hole: �l t V` Weeping from Pit Fnce Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE iv o G w Method Used: Depth Observed standing in obs.hole: In, Depth to soil mottles: ►n, Depth to weeping from side of obs.hole: in, Groundwater Adjustment f[. Index 15Ve11# Reading Date: Index Well level Adj,factor,,,,,,,,,,.a,, Ad&d;Uttdwater Level PERCOLATION TEST Date '1']tne. Observation %q 0k4_ Hole# Time at h" ...W. Depth of Perc Time at G' Start Pre-soak Time @ Time(9"-V) End Pre-soak Rate Min./Inch Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- i ***Ifipercolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one (1) week prior to beginning. Q:\S EPTIC�PERCFORM.DOC i i DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soii Texture .Sdil Color Soil . Other Suifac�e(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. 1 olisistency,%Orav61) 2 4P j • DIMP OBSERVATION HOLE LOG Hole# Depth from I SAjj Wpion Soil�Teature• Soil Color Soil Other Surface(in.) (U§DA) " (Munsell) Mottling (Structure,Stones,Boulders. onsis en % -7- o L 1A, 7 F i DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. O y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders, Consistency. i i l+lood Insurance Rate Man: Above 500 year flood boundary No— Yes . _ Within 500 yeatUgndary _ Nc Yes _ Within 100 year,ftood'boundary N6:L __Yes Depth of Natural ccurrm 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? If not, what is the depth of naturally occurring pervious material? Certification I certify that on ( �" (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Date Signature —=�— Q:wmyriC�PERCFORM-DOC Town of Barnstable Barn Regulatory Services Department AMmedimM 3 URNST M ► 1 I r a, ' Public Health Division m 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7014m 1200.0001 0358 0123 September 8, 2014 Edward P & Timothy J Garneau 251 Woodside Road West Barnstable, MA 2668-1740 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 14 Pena Way, Centerville, MA was last inspected on July 28, 2014, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts." The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is .in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. R OF TH' OARD OF HEALTH (:64masKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\14 Pena Way Cent 2014.doc i I Commonwealth of Massachusetts --- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is Centerville MA 02632 Jul 28, 2014 required for every — y page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information / on the computer, use only the tab 1. Inspector: key to move your cursor-do not Patrick M. O'Connell use the return Name of Inspector key. ray Company Name PO Box 1487 Company Address I Marstons Mills MA 02648 City/Town State Zip Code 508-776-4186 S1 12855 Telephone Number License Number B. Certification I certify that 1 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 16.340 of Title 6 (310 CMR 16.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority ti July 28, 2014 I ors lgnature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. o � : II l5ins-3113 Title 5 OffWicial Inspe C n nn:Subsurface Sewage Dispo al System-Page 1 of 17 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 'Y 14 Pena Way Property Address Timothy& Edward Garneau Owner Owner's Name information is required for every Centerville MA 02632 July 28, 2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E /always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated.are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old" or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t51ns-3/13 - Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 2 of 17 r t \ , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is Centerville MA 02632 July 28, 2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed.pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) ate replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(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 l5ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy& Edward Garneau Owner Owner's Name information is Centerville MA 02632 July 28, 2014 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has aseptic 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: ** he II water analysis, performed at a DEP certified laboratory, for fecal This system asses if t we w . Y p Y . p rY coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/z day flow t5ins•3/13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy& Edward Garneau Owner Owner's Name information is required for every Centerville MA 02632 July 28, 2014 page City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area — IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I �. Commonwealth of Massacfiusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is Centerville MA 02632 Jul 28, 2014 required for every y page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate "yes" or"no" as to each of the following.- Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? Have large volumes of water been introduced to the system recently or as part of �] ® this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) • ❑ Was the facility or dwelling inspected for signs of sewage back up? • ❑ Was the site inspected for signs of break out? X ❑ Were all system components, excluding the SAS, located on site? M ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of.Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information---------------- - ------------------ ------- ----- Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 151ns•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 6 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is required for every Centerville MA 02632 July 28, 2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ❑ No Seasonal use? ❑ Yes ® No' Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Currently Occupied. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow (based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Forms Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessment: r 14 Pena Way - ' M Property Address Timothy & Edward Garneau - Owner Owner's Name information is Centerville MA 02632 July 28, 2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Unknown Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract (to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Suosurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts UpTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Gameau Owner Owner's Name information is Centerville MA 02632 Jul 28, 2014 required for every Y page. City/Town State Zip Code Day,of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: Unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1 feet Material of construction: ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Septic Tank (locate on site plan): Depth below grade: 8 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: 8.5' long x 5.2'wide- 1000 gal. Sludge depth: 2 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary,Assessments 14 Pena Way Property Address Timothy & Edward Gameau Owner Owner's Name information is required for every Centerville MA 02632 July 28, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 28 Trace Scum thickness Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Liquid level was found at bottom of outlet invert and baffles were intact and clear. Observed solids on top of outlet baffle and staining to top of tank indicating hydraulic failure. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 _ Title 5 Official Inspection Four:Subsurface Sewage Disposal System-Page 10 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner owner's Name information is required for every Centerville MA 02632 July 28,2014 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract (required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments w 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is required for every Centerville MA 02632 July 28, 2014 page. Cityrrown State Zip Code. Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any, evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): ' If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Otflcial.Inspection Form.Subsurface Sewage Disposal System-Page 12 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy& Edward Garneau Owner Owner's Flame information is required for every Centerville MA 02632 July 28, 2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: One 6x6 pit. ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Liquid level was found within 6"of inlet invert with staining to top of structure. Town standards require a minimum of 12"of effective leaching to constitute a passing leaching system. Leaching pit is in hydraulic failure. 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Gameau Owner Owners Name information is MA 02632 Jul 28, 2014 required for every Centerville y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 14 of 17 a i Commonwealth of Massachusetts Tithe 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 14 Pena Way Property Address Timothy& Edward Garneau Owner Owner's Name information is Centerville MA 02632 Jul 28, 2014 required for every Y page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes bei.-Iw: ® hand-sketch in the area below ❑ drawing attached separately c 0 � 0 U 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal system•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 14 Pena Way Property Address Timothy & Edward Garneau Owner Owner's Name information is Centerville MA 02632 Jui;,28, 2014 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells N/A Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -.explain: ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 17 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 DEEP-OBSERVATION HOLE LOG Hole# 1 Depth from Soil Horizon Soil Texture .Soil Color Soil Other ` Suifa ce(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. ` onsistency.96 Ciravel) v .its% DEEP OBSERVATION HOLE LOG Hole# Depth from Soil-Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsisten % D- ZsD I-',tx- -Zf- tto) �YrZ DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No _K' Yes / Within 100 year flood boundary No`� 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? e-- If not,what is the depth of naturally occurring pervious material? Certification ' I certify that on l .(� (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 510 CMR 15.017. Signature L Date y �C Q:VSEPTIC�PERCFORM.DOC Town of Barnstable P gyp,' Department of Regulatory Services Public Health Division Date MAM ia3q �� 200 Main Street,Hyannis MA 02601 �y�l jFb trt►ri� //Time Date Scheduled ,, Fee Pd. Soil Suitability Assessment for Se Dis s Performed ByseFeW ��e�/ 7- Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name �L AC<NJC—a4U ^11,� Address I q- PDJA � C 61-4 !V f C-G� Assessor's Map/Parcel: p4 ' (P / f qq Engineer's Name(�Qee)tp4 NEW CONSTRUCTION REPAIR ^ Telephone# 502 Z Z Land Use ` � ! Slopes(%) t 2 Surface Stones Distances from: Open Water Body?,30,�, ft Possible Wet Area Drinking Water Well7C3'0 ft Drainage Way All ft Property Line ft, Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) Z Rat ° `" - O P r5 N A7 UNJ/V -( Parent material(geologic) (J CA1�t5"` Depth to Bedrock /Q fjL\ Depth to Groundwater. Standing Water in Hole: �Q STD —� P g. Weeping from Pit Face Estimated Seasonal High Groundwater 7 j Z0 DETERMINATION FOR SEASONAL HIGH WATER TABLE N o G w Method Used: Depth Observed standing in obs.hole: __—_____In, Depth to soil mottles: itt. Depth to weeping from side of obs.hole: in, Groundwater Adjustment f[. Index Well# Reading Date: Index Well level „ Adj,factor,,,,,,m,4 Adj.Groundwater Level PERCOLATION TEST Date Thne Observation Z_ Hole# Time at 9" Depth of Pere Time at 6" Start Pre-soak Time @ d,���,n Time(9"-6") End Pre-soak Rate Min./Inch Z� t I.. Site Suitability Assessment: Site Passed_ a� Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back---------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the. Barnstable Con'selrvation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) :yr DATE: D/'L TN r,l 77i C Fill in please: a� APPLICANT'S YOUR NAME: O 4 BUSINESS YOUR HOME ADDRESS: �T,9,Q dlf ,Sog-�7(0-6313 cam'/�17— c)r c mac- Gl/L G¢- y 'z-.6 3 a - -2 O TELEPHONE # Home Telephone Number NAME OF NEW BUSINESS D/'�&/ZT �9bS i�.,z'�/ TYPE OF BUSINESS %/ JL- IS THIS A HOME OCCUPATI N? YES .,2�NO _ �L ,¢ic/ Have you been given approval from the building dt4ision? ES�O e �/�T�� ADDRESS OF BUSINESS -.�L t�DV7 /y MAP/PARCEL NUMBER When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1 BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH '`' This individual hPzed n in rmd of the per i quirements that pertain to this type of business.hori Signature** COMMENTS: � � e 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: COMMONWEALTH OF MASSACHUSETTS v ` EXECUTIVE OFFICE OF ENVIRONMENTAL, AFFAIRS DE Alt- OF ENVIRONMENTAL PROTECTION a es aid�C U TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASS SSMENTS� SUBSURFACE SEWAGE DISPOSAL SYSTEM FO C-, t PART A � = , CERTIFIC ATION Property Address: © � Ls Owner's Name: .._.a Owner's Address: C"- r� Date of Inspection: (j S W rn Name of Inspector:(please print) { 0)0 Company Name: 1 11 � Mailing Address: 0 .� 1O v Telephone Number: — — c�G CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and was performed based po that the reported information repo below is true,accurate and complete as of the time of the inspection.The inspection training and experience in the proper function and maintenance of on site sewage was systems.I am a DEmy P approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system; Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: .� �„ ,A �J Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 r - Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: AN!Y\�a _ "*CKy \% Owner• YY1 Date of Inspection: OS 1 0 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: I * B System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaire The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no r not determined(Y,N,ND)in the explain. for the following statements.If"not determined"please The septic tank is tal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substan' tration or exfiltration or tank failure is imminent System will pass inspection if the existing tank is replaced with a omplying septic tank as approved by the.Mi d of Health. *A metal septic tank will pass . ction if it is structurally sound,,Rotrleaking and if a Certificate of Compliance indicating that the tank is less than 2 ears old is available. ND explain: Observation of sewage backup or bream ut gh static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settl d or uneven ' tribution box.System will pass inspection if(with .approval of Board of Health): roken pipe(s)are replace obstruction is removed distribution box is leveled or replac ND.explain: The system required pumping more than 4 times a year due to broken or obstruct ipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed .l ND explain: T;+ln C Tna we4;n" re-m An gnnnn 2 r Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: !4 pc 'S Owner: t7A:V&w\ Ippattim Date of Inspection: c, p C. Further Evaluation is Required by the Board of Health: Co itions exist which require further evaluation by the Board of Health in order to determine if the system is failing to otect public health,safety or the environment. 1. System ill pass unless Board of Health determines in accordance with 310 CMR 15303 1( )�bj that the system is t functioning in a manner which will protece public health,safety and the environment: _ Cesspool rivy is within 50 feet of a surface water _ Cesspool or vy is within 50 feet of a bordering vegetated wetland or a s marsh 2. System will fail unless the Board o ealth(and Pub Water Supplier,if any)determines that the system is functioning in a manner that p ects the pu c health,safety and environment: _ The system has a septic tank and soil abs on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface at supply. The system has a septic tank and S and the SA " within a Zone 1 of a public water supply. _ The system has a septic tank d SAS and the SAS is wi " 50 feet of a private water supply well. The system has a septic and SAS and the SAS is less than 0 feet but 50 feet or more from a private water supply well** ethod used to determine distance **This system passes " a well water analysis,performed at a DEP certified boratory,for coliform bacteria and volatile o gardc compounds indicates that the well is free from pollu " n from that facility and the presence of nia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, rovided that no other failure criteria are ggered.A copy of the analysis must be attached to this form 3. Other: T;+1a c r.,o..A,.r;.,.,Fnr..,Oil cnnnn 3 IPage4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1- Owner: Date of Inspection: 6 S D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes Nq cJ Backup of sewage into facility or system component due to overloaded or clogged SAS or cess pool 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%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 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 collform 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 in ' ate either"yes"or"no"to each of the following: (The following ' eria apply to large systems in addition to the criteria above) yes no. _ — the system is witlun feet of a surface drinking water suppl — _ the system is within 200 feet of a to a surf irinldng water supply _ — the system is located in a nitrogen sensitiv ea Inte Zone II of a public water supply well ( ad Protection Area_IWp.q)or a gypped ' If you have answered"yes"to an /i Y y questiodin Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Tifln i Tnonsi.}inn TJnrrs,�ii ci�nnn 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: cA, Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health _ J .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? _ J 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) j _ 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? J_ _ 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? J _ 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 _ _,I Existing information.For example,a plan at the Board of Health. J _ 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)] I Title G 4/1 i/)Ann 5 C Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: Owner: Date of Inspection: Q FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual)2 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2 Z O Number of current residents: "- Does residence have a garbage grinder(yes or no): i1b Is laundry on a separate sewage system(yes or no):11.0 [if yes separate inspection required] Laundry system inspected(yes or no):)�So Seasonal use:(yes or no):1%0 Water meter readings,if available(last 2 years usage(gpd)): ►,Ltd} Sump pump(yes or no):h4 Last date of occupancy:4��-+ COMMERCIALANDUSTRIAL Type establishment: Design ased on 310 CMR 15.203): ,d Basis of design o is/persons/sgft,etc.): Grease trap present(yes or no . Industrial waste holding tank present(yes o Non-sanitary waste discharged to the Title 5 system e Water meter readings,if available: .Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: pvJ Was system pumped as part of the inspection(yes or no):�(} If yes,volume pumped: >;allons--How was quantity pumped determined? Reason for pumping: T)VPE 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 components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no): � T41a 4 Tnar%ar*inn vnrrn An aiinnn 6 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: e1 Date of Inspection: BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: cast iron _40 PVC other(explain): Distance from private.water supply well or suction line: t(--,t i Y1 Comments(on condi 'on of jo�' ,venting,evidence of leakage,etc.): In o r.n.�o.. �4-f jP v4 cti.cv r^ SEPTIC TANK:_(locate on site plan) Depth below grade: Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 22 Scum thickness: L ,(- r Distance from top of scum to top of outlet tee or baffle:�=c) 7 a r-X--C` `-e�/� t S Distance from bottom of scum to bottom of outlet tee or baffle: _` How were dimensions determined:- 'py-oh . Comments(on pumping recommendati ns,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,e�ence of leaks e,etc. anCe 1red GREASE TRAP:_(locate on site plan) Depth belavKga de:_ Material of cons G ' n:_concrete_metal_fiberglass_polyethylene_other (expo)' 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 b e: Date of last pumping: Comments(on pumping recommendations ' and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence o ge,etc.): Title S Tnensntinn Fnr.n lip ei�nnn 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: Owner: e Date of Inspection: Qp TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materi construction: concrete meta( fiberglass_polyethylene o lain): Dimensions• Capacity: Design Flow: f;allons/day Alarm present(yes or no): -- Alarm level: Alarm in g order(yes or no): Date of last pumping: Comments(condi ' of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) i Depth of liquid level above outlet invert:-CL Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or ut of box,etc. : o e Y� PUMP CHAMBER: (locate on site plan) Pumps in wor er(yes or no): Alarms in working order no Comments(note condition of pump c n of pumps and appurtenances,etc.): r Title i TnanAr-*inn Pf%rm 4/1'qnMA 8 IPage9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ` SYSTEM INFORMATION(continued) Property Address: "1 'PC NBC` W Owner: Date of Inspection:--- SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type leaching pits,number:--� p U o CA_1 leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Typetname of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): ��in o pi a 1 ka \N4 CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N er and configuration: Dep top of liquid to inlet invert: Depth o lids layer: Depth of sc layer: Dimensions of c spool: Materials of cons tru 'on: —�. Indication of groundwat ' ow(yes or no): Comments(note condition o signs of hydraulic failure,level of ondQ2,condition of vegetation,etc.): PRIVY: (locate on site plan) Materials of construction- Dimensions: Depth of solids- Comments.,(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title i Tnonnnfinn Fnr A/1,gmnnn 9 Page 10 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ��' Owner. Date of Inspection: SXXTCH 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 eaters the building. pec\� A �- a do (�Z _ ��ti��� �z� G-31 i in Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 10 Pt wolantOwner: ` Owner: .gas e-- CV-�e&L Date of Inspection: SITE EXAM n n Slope Surface water Check cellar Shallow wells r Estimated depth to ground water feet I Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: `S —2 C r=(jy`Q, G (-��j;_ q Y u must describe how you establis d the high ground water el e ation: 6S oevc�e res f S . no Tit1a i Tnennrtinn vnr r,il gi,7nnn 11 t 0 �-o—n- vm- erx).�-�—copp -,Cktr-,, �S--Ow- --corld o�Due--. cx A C)6 53 wNbes-- -40 �6 s—s-e �\-C, w �1._._:�__j c�S_I�._�....�ir�_doe✓�_t__-�,_C�u`O..vr�..d--�----,�e--..�...1!1�� _D , S VCe 3 __ n Idr .. 1 d • . S . — _..�.. _�_..T..—_�_ • a____ __ ..._ �—_. _.__ __ram___.. � _�. t y 1 /• r � 1 y Roberts Septic P.O. Box 1557 Hyannis, Massachusetts 02601 ph. 508-778-1898 fax 508-790-9732 June 4, 2005 Pelham 14 Pena Way Hyannis, Massachusetts re: septic system inspection The above mentioned property was inspected by Josh Roberts. At the time, per State D.E.P. regulations, the observed groundwater height was recorded. With concerns of groundwater fluctuations and observations, the inspector has done an additional deep hole test at the property. On this date, June 4, 2005 at 1:20 p.m., a backhoe/loader dug to a depth of 9+ feet. The deep hole test was performed in close proximity to the existing leaching of the septic system. Standing groundwater was'observed at a level of 9 feet 1 inch. In addition this standing groundwater was observed by 4 witnesses. Signed and Witnessed, _ -mil-a S oberts fied D.E.P. Ins ector Rodger . Roberts, c choe Operator ` �f Ch is inne /4(evinThatcher COMMONWEALTH OF MMSACHUSETTS �'� �`' cp-6P`2-T- EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �-A"/6- DEPARTMENT OF ENVIRONMENTA4-�-P :C. Ip E Y ?0-0 ^ M : TITLE 5 a_.._-...._... IVISId� OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMEN SUBSURFACE SEWAGE DISPOSAL SYSTE M FORM PART A CERTIFICATION Property Address: Owner's Name: Owner's Address: I, Date of Inspection: b lI S Name of Inspector: lease riot Company Name: p ) Mailing Address:�T o(�, Telephone Number: _ 26 `6Ct% CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the informa on r below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my ti eported training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails Inspector's Signature: A l� Date: The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 I Page 2 of 11 - OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: '��2 Y\.6- .A-vhr� Owner• 1(Yl Date of Inspection: C () Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: I ^ 0.tiACVv e4e B System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaire The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no r not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is tal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substan' ' tration or exfiltration or tank failure is immii ent:System will pass inspection if the existing tank is replaced with a omplying septic tank as approved by the.B6ard of Health. *A metal septic tank will pass . ction if it is structurally sound,not'eaking and if a Certificate of Compliance indicating that the tank is less than 2 ears old is available. l ND explain: Observation of sewage backup or breal static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,setfl dor uneven . tribution box.System will pass inspection if(with .approval of Board of Health): roken pipe(s)are replace obstruction is removed distribution box is leveled or replac ND explain. The system required pumping more than 4 times a year due to broken or obstruc ipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Titles i lnana,-+inn r.nrm F/1 i/MMn 2 f Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS } SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: pe `S Owner: Date of Inspection: f p C. Further Evaluation is Required by the Board of Health: Co 'tions exist which require further evaluation by the Board of Health in order to determine if the system is failing to otect public health,safety or the environment. 1. System III pass unless Board of Health determines in accordance with 310 CMR 1530 3(1)(bl that the system is t functioning In a manner which will proteca public health,safety and the en "onment: — Cesspool rivy is within 50 feet of a surface water — Cesspool or 'vy is within 50 feet of a bordering vegetated wetland or a s marsh 2. System will fail unless the Board o ealth(and Publ Water Supplier,if any)determines that the system is functioning In a manner that p ects the pu c health,safety and environment: The system has a septic tank and soil abs on system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface at supply. _ The system has a septic tank and S and the SA within a Zone 1 of a public water supply. _ The system has a septic tank a d SAS and the SAS is wi ' 50 feet of a private water supply well. The system has a septic and SAS and the SAS is less than 0 feet but 50 feet or more from a private water supply well** ethod used to determine distance **This system passes if a well water analysis,.performed at a DEP certified boratory,for coliform bacteria and volatile o ganic compounds indicates that the well is free from pollution from that facility and the presence of nia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,Rrovided that no other failure criteria are ggered.A copy of the analysis must be attached to this form 3. Other: Tiflr.i T»c»nrfin»Rnrm A/I c/7nnn 3 Page 4 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS l SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: i— f\1 Owner: Date of Inspection: 0 S D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes Nq e/ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6"below invert or available volume is less than%:day now Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped _ Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone 1 of a public well. _ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds Indicates that the well is free from pollution from that facility and the presence of ccompammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp Provided provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] o (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 in ' ate either"yes"or"no"to each of the following: (The following c 'e 'a apply to large systems in addition to the criteria above) Yes_ no, _ the system is within feet of a surface drinking water suppl _ — the system is within 200 feet of a to a surf drinking water supply — _ the system is located in a nitrogen sensitiv ea(late ad Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"Yes"to an / i Y y questiodin 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 significant threat under Section E or failed under Section D shall upgrade the system in accor d dance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Tifln i T++or+nrtinn Fnrm!./��/7/1!1!1 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: � Owner: u� Date of Inspection: Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _ Pumping information was provided by the owner,occupant,or Board of Health _ Were any of the system components pumped out in the previous two weeks? _ Has the system received normal flows in the previous two week period? _ Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined?(If they were not available note as N/A) J _ 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? J _ 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? J _ 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 _ 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)) Tifla ,c Tnonarfinr 17nrm A/T;p7n 1n 5 Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS ` SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: IJ Owner: Date of Inspection: o FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual)? DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 2 7_0 Number of current residents: I Does residence have a garbage grinder(yes or no): t\tS Is laundry on a separate sewage system(yes or no):.M (if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no):r 1 Water meter readings,if available(last 2 years usage(gpd)):_J,) lA Sump pump(yes or no):�6 Last date of occupancy: �t�,S�_+ COMMERCIALANDUIST—RI`AL Type establishment: Design ased on 310 CMR 15.203): amd Basis of design o is/persons/sgft,etc.): Grease trap present(yes or no . Industrial waste holding tank present(yes o Non-sanitary waste discharged to the Title 5 system e 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 inspection(yes or no):_1\_(') If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shaied system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewage odors detected when arriving at the site(yes or no):` (] T41a C r»cnar+inn rnrm Oil ai,7nnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` PART C SYSTEM INFORMATION(continued) Property Address: 114 fvsti WS 1 Owner: e, Date of Inspection: t BUILDING SEWER(locate on site plan) lk r� Depth below grade: 12— \� Materials of construction: cast iron _40 PVC other(explain): Distance from private water supply well or suction line: I:uvi vi Comments(on condit*on of join,venting,evidence of leakage,etc.): SEPTIC TANK:_(locate on site plan) a r� Depth below grade: — Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):—(attach a copy of certificate) k Dimensions: Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: 3 It 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: Z` `� - S How were dimensions determined: AYb V,,5 Comments(on pumping recommendati ns,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to o et invert,evidence of leaks e,etc. : -I I f CihC2 .��'f eU GREASE TRAP:_(locate on site plan) Depth be w de:_ Material of cons on:_concrete_metal_fiberglass_polyethylene_other (explain): — Dimensions: Scum thickness .�� _s:__ Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or e: Date of last pumping: Comments(on pumping recommendations ' and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence o ge,etc.): Titlo 4 Tncr%r►r4in»Form!11,;ionnn 7 Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: I.L A -D `ICJ Owner: C. Date of Inspection: ig 1 EWT�- TIGHT or BOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Materi construction: concrete metal fiberglass_polyethylene o lain): Dimensions: Capacity: Design Flow: aallons/day Alarm present(yes or no): _.....Alarm level: Alarm in g order(yes or no): Date of last pumping: Comments(condit}o of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) i Depth of liquid level above outlet invert:-CL Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or ut of box,etc.): © eY PUMP CHAMBER: (locate on site plan) Pumps in wor er(yes or no): Alarms in working order no): Comments(note condition of pump cutups and appurtenances,etc.): T;tla 4 irw, f;f%n 17—m A/1 t/,)nnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS 1 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) "1 t' Property Address: ( `,C nc` QX'-4- � ��� Owner:—Pe 1J x Date of Inspection:--In--5 I I 's �d S SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Tvne leaching pits,number: q U (� CA_' leaching chambers,number: leaching galleries,number: leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) N er and configuration: Dep top of liquid to inlet invert: Depth o lids layer Depth of sc layer: Dimensions of c spool: Materials of constru 'on: Indication of groundwat ' ow(yes or no): Comments(note condition o signs of hydraulic failure,level of p ,�condiLtionn vegetation,etc.): PRIVY: (locate on site plan) Materials of construction- Dimensions: Depth of solids- Comments,-note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Title i Tna»nntin» Fnrm!�1 v�nnn 9 Page 10 of 1 l OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: ��" pev�c,. WG'� Owner. Date of Inspection: SXETCH 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 eaters the building. ZL1 c v p ec\c- o -P3 Lid 2-1 l 33' (31 Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: t Owner: Date of Inspection: is jo S SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water _J+_feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach docume__Station) T G Accessed USGS database-explain: �L —2 6y`e, (�Cj ( 9 ZJ 1 l You must describe how you establis d the high ground water ele ation: 1 O o o � Titlo r%Tnenartinn P^n F./1 grmnn 11 O 71C A T I 0 N S [ WAG E PE RMh N0 vll � cE �. os V E hNSTA I. I. E. NAME i ADDRESS U �S 1 S U I L D E R OR 0WofECR e' �tlS 7/ Al 41C DATE PERMIT ISSUED DATE COMPLIANCE ISSUED ii _I _ LOCATION SEWAGE PERM1.1 N0. t Ill GE I"NSTA LLER'S NAME i ADDRESS U7-eDAS ® UILDE R OR OWNER > DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 9 " rr. g' ,. y� No... .........ul t Fis.............................. THE COMMONWE„ALTH OF MASSACHUSETTS MAP 2�(� BOAR® OF HEALTH PARCEL l .............OF........ lR.�/ST �L JE ............. 2 Apptiratilan for Uiipniittl Workii Tonstrnrtiun rrmft Application is hereby made for a Permit to Co (9) or Repair ( ) an Individual Sewage Disposal System at: t t4 F^! 1.ti ---•----------------------------- ---•--..... QT._..z -- ................ . Location-Address or Lot No. x��s y,4�!F ._ ...... 5.. E s _.. ._ .rAl � . ti[ ................... Ic L 1 1`F Owner_ Address eG Q nstaer ° �............... .....-----------....a AddressPQ UType of Building Size Lot---73 _..7 ...Sq. feet Dwelling—No. of Bedrooms...........3............................Expansion Attic ( ) Garbage"Grinder (Nil) aOther—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) P4 Other fixtures ................................. •--- �j "" o"o O gallons. W Design Flow..............IJ_.__.....................gallons per �r-sen per ay. Total daily flow_________.._.3�__._...................gal WSeptic Tank—Liquid capacity./2040.gallons Length� .fa.... Width_¢'�d__ Diameter________________ Depth.... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------I......... Diameter.../....,?......... Depth below inlet....... Total leaching area..24.3....sq. ft. Z Other Distribution box (x) Dosing tank �.._2 ~' Percolation Test Results Performed by.__. ....._-/- UG.I�l___.___._._r__________________ Date... as Test Pit No. 1... .Z-___minutes per inch Depth of Test Pit-------/a...... Depth to ground water.......-J..:........... Test Pit No. 2................minutes per inch Depth of Test Pit..................... Depth to ground water........................ .� ...... ........ ..:........ ------- ----------------------•------•-------.--------------•- O Description of Soil ;; ��:, ors _._...:.- � SO-------- U ..................•• -••..Z _._'_.�� 4, 9�!!--------MF SAiCG - W -----•--•---------------•-------•---------------•-----------..........••.................-----•------------... UNature of Repairs or Alterations—Answer when Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITti- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee ed b the boarGshe Sign -• --•- . •... Date Application Approved By............. -- •. •..---- --- ...... ..V-f!!X1.......... Date Application Disapproved for the following reasons-------------------------------------------------------•-----------------------------------------------••-.----- ..---•------•---••••-••••-----------•--••••-•-------------••----•-••-•-----------•--........••----•----•----••---....-•-------------•••••--•--•-••----•-•-•••--------•---•---•-----•=......-----......_ Date Permit No....... �-_22;0 - Issued r�................- Date i - s� No------------------------ a Fizs..........................._. THE COMMONWEALTH OF MASSACHUSETTS BOARD sOF HEALTH .. .._... AppfirFa#ion for Disposal Works Tonstrurtion Prrmit Application is hereby made for a Permit to Construct (X ) or Repair ( ) an Individual Sewage Disposal System at: 1�i.ni f,� �,�_:iG%------`------------------------------------------•-----..............._. ................ .. - .... ..... - . ...-------- Location-Address Lot No. --j7. ............... TR..Owner ta�L ------t�(r4 �1 'fir:........ rA.�/ti rr-----Av l--------------- a ---------------- ' Installer A dress Type of Building Size Lot... ..7.4; ___.Sq. feet UDwelling—No. of Bedrooms__._....___3............................Expansion Attic ( ) Garbage Grinder ( ) `4 04 Other—Type of Building No. of persons............................ Showers — Cafeteria a' Other fixtures ................................._ CSC"!SlZGo -•------------- ---•-•--••----•-- ----••--•-•------•-- ................................... ---- W Design Flow.............I/A..................... per per-son per day. Total daily flow-----_....... ....................gallons. WSeptic Tank—Liquid capacity/l�GU_gallons LengthS.'=.6..__. Width 4--/G_- Diameter________________ Depth_... x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No---------/---------- Diameter__-_2.......... Depth below inlet.....4.......... Total leaching area..4z.3....sq. ft. Z Other Distribution box (X ) Dosingt�..t�ank Percolation Test Results z Performed by...1.�. �111 a1................................ Date_.___ '' ___ �f..._.. L _ Test Pit No. -................minutes per inch Depth of Test Prt......1________.__ Depth to ground water-------- _____._..__. � Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water................... D Description of Soil... .... -`z�........... � ?......--_..�.._-•-•-- ----�3sG.. t --------------- .. W -----•-----•----------------••----••-------•----•--......•-•--------•-••-•-••--•••-•------•-•-•--...-------•-• -- -;0..........---------------•--••-----•---•--------•---.............................. UNature of Repairs or Alterations—Answer when applicable..-/. 4/1..............................................................................•._.. ..------••--------•-------------------•---------------------------••-------•-------•-••-•--•--•--------...-•---------------------•----------------•------------------•------------------..........-• .. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT iZ- 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has bee�d o r o e Ith. Signe .................. ................................ Date Application Approved By............. .•..... •'--- +j -------- 1 .......... Date Application Disapproved for the following reasons-.-----------------------•--•--------•-----••---•--...------•----...-•-•-------------........................... ---------------•---•--•-- :.. •-•----------------•--------•-------------------------------------------•----•...................................................................... ,- Date , PermitNo.. �-----•---- ............ - Issued_ ............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF........................__......................................................... (9rdifiratr of TompliFanrr y THIS IS TO CERTIFY That the Individual Sewage Disposal System constructed ( . ) or Repaired ( ) bY.......................... ._ Lf ......---- ----------•-------. ------------•-----------............--j..............................---...........---•-----•--....... at................................... ----•----•-- - ......•.lost-a. 7............""_ --------------------------------------------------- has been installed in accordance with the provisions of TI 112 1 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No........ 1"__6.2- ..1. dated------------------------------------------------ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTkUED AS A GUARANTEE THAT THE SYSTEM WILL^FUNCTION SATISFACTORY. � DATE...... .- ? ... Inspector. - -- -.---- THE COMMONWEALTH OF MASSACHUSETTS ~' BOARD OF HEALTH .........................................O F....................... NO.... ..�1�� FEE.... ................... 1 Disposal Works To s#rnr#ton Vrrmit Permission is hereby granted................... U __....- SMr e Dto Construct orR dual Sewage an at ...._..... .A? Street as shown on the application for Disposal Works Construction Permi o.-___--__-_.._ ted----------------------•------------__._-- -s .----.. -x....... ... �- .................................................... Bo r of ealth FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS CERTIFIED MAIL TM U.S.POSTAGE>>RTNEY BOWES °FIRE'°wti Town of Barnstable - P ° Public Health Division r � —� EARN_ABLE. 200 Main Street @„A�. ZIP 02601 $ 006.48" �plEO MP�a`0 Hyannis,MA 02601 , ��. 0001383424 AUG. 12. 2014, I 7012 1010 0000 2851f4297 1 t � Edward P & Timothy J Garneau f 14 Pena Way - - ' � Centerville, MA 02632_. �/ ®�Cit`7s/. /JK�//� etS. e�a.v et Z,rrj..i.=r j 1 t •. - S'`�...�i^`I Li'P�i�_r z � 13��'3 L'c f�'L+�-8\+x'� •.NOT DELI'V.E�tA9LF. AS A,00RESSE3) 9v. 02-6'1—m 1.4e :2:: jilt 11111111111ills9�i�lllli, ,it�s�'��� 9��1}1�{►�1�ofE� rlii�ll. COMPLETE THIS SECTION ON DELIVERY SENDER: COMPLETE THIS SECTION ■ Complete items 1,2,and 3.Also complete A. Signature N❑.Agent I item 4 if Restricted Delivery is desired. I C I ■ Print your name-and address on the reverse X ❑Atld e- I so-that we can return the card to you. B..Received by(Printed Name) JC. Date of Delivery i ■ Attach this card to the back of the mailpiece, { ` =2 i or on the front if space permits: t 1 i D. Is delivery address different from item-1? ❑Yes I , 1, Article Addressed to: If YES,enter delivery address below: ❑No I Edward P:&Timothy J Garneau ' 14 Pena Way i. 0. 3. Service Type `Centerville., MA 02632 I ❑Certified Mail [:]'Express Mail ❑Registered ❑Return Receipt for Merchandise I ❑Insured Mail ❑C.O.D. I I — ' a •� 4. Restricted Delivery?(Extra Fee) ❑Yes 1 _ I ' J 2. Article Number:' s'. (rransfer from service label) 7❑12 1010 0000 2851 4297 PS Form 3811.February 2004 Domestic Return Receipt �02595-02-M-1540 Town of Barnstable Barn Regulatory Services Department P RAW-MABLB. 9q, 059. Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL #7012 1010 0000 2851 4297 August 13, 2014 Edward P & Timothy J Garneau 14 Pena Way Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 14 Pena Way, Centerville, MA was last inspected on July 28, 2014, by Patrick O'Connell, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • System is in hydraulic failure. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. jP>ERORDER OF HE BOARD OF HEALTH cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\14 Pena Way Cent 2014.doc LEGEND St N — 100 —— EXISTING CONTOUR O g x 100.98 EXISTING SPOT GRADE ° EXISTING SEPTIC TANK M LOCUS v (APPROX. LOCATION) ^, W EXISTING WATER SERVICE Pena _ N G EXISTING GAS SERVICE WOy o' s INV.(OUT)=101.5± n rt —6.H. W.--OVERHEAD WIRES C-n TEST PIT Chadwick EXISTING LEACH PIT BENCHMARK BENCHMARK (APPROX. LOCATION) Craigviiie Beach Rood OUTSIDE COR.10ECK CONTRACTOR SHALL PUMP, EL.=105.97 FILL WITH SAND & ABANDON Creep Dunes s a M _ LOCUS MAP N 80'02'40" W NOT TO SCALE bl 93.00' GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL fence BOARD OF HEALTH AND THE DESIGN ENGINEER. 101, 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS x7DECK O 103.18 102.64 OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE BM LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: 101,2105,97 x + 2,9 \ SHED —3) 3' variance th x 104.38 1) A 3' variance to the maximum cover requirement of 3 , for 03,12 to 6' of cover over the S.A.S. x 103,16 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 103,32 TP-1 TP-2 -9 TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE x W DESIGN ENGINEER. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING p ` 0 0 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN EXISTING 102, �:';' +G(y102 80 ao P' ENGINEER BEFORE CONSTRUCTION CONTINUES. 1LOM I ,: vi p i 5. ALL ELEVATIONS BASED ON AN ASSUMED DATUM. _ • 00 HOUSE(#14) y i i, ;.. o as00 o .n ":•" " 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF X 100,6� T.O.F.=105.5f ;;QCis� THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF Vl LYE a" z HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 03,37 .•:. �,; x 102.86 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE 8. THERE ARE NO ABUTTING WELLS WITHIN 150' OF THE PROPOSED S.A.S. .. . .• :•:,..�.X X o:.,:;:.: x 103,40 0 ? VENT g 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS o. a a AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE I �- x .' �`: ' �OcZ DIRECTED BY THE APPROVING AUTHORITIES. 102.54 LOT 2 C� 102,9 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY x 7735±SF �:GRAVEL '..:..X. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING BL 246-199 °' CONSTRUCTION. 101, 'DRIVEbyAY:10 80� 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS 93.00' 100.06:...•,..' IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND 100.37 101.62 3 _ _ '0 � 100,45 UP REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE UP 100,17 EDGE OF GRAVEL ROAD 100.79 INSPECTED BY HEALTH DEPARTMENT PRIOR TO BACKFILL. 99.21 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND 99.15 • 100,00 IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. PK SET 14. THE ENGINEER IS NOT RESPONSIBLE FOR ANY UNDOCUMENTED SEPTIC � OF M4ss9�yG SYSTEM COMPONENTS NOT SHOWN ON THE PLAN. P F �rA WAY o PETER T. PROPOSED SEPTIC SYSTEM UPGRADE PLAN Mc 14 PENA WAY, CENTERVILLE, MA � CIVIL CIVIL "' OWNER OF RECORD } No. 35109 Prepared for: Copewide Enterprises, 153 Commercial St, Mashpee, MA 02632 GARNEAU, EDWARD P & GISZ �� SCALE DRAWN JOB. NO. TIMOTHY J S IN E�� Engineering by: T�� 14 PENA WAY Engineering Works, Inc. 1 =20� P.T.M. 116-15 CENTERVILLE, MA 02632 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. �J1 51 1 t57 (508) 477-5313 3/2/15 P.T.M. 1 Of 2 f I� NOTE: TO PREVENT BREAKOUT, THE PROPOSED FINISH GRADE SHALL NOT BE < EL: 99.5 FOR A DISTANCE OF 15' AROUND THE PERIMETER, OF THE S.A.S. SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. INSTALL RISERS & COVERS OVER INLET & INSTALL WATERTIGHT RISER INSTALL H-20 WATERTIGHT RISER, FRAME & COVER OVER OUTLET AND SET TO 6' OF FINISH GRADE & COVER TO WITHIN 6" OF ONE CHAMBER(MIN.),AND SET TO FINISH GRADE TO SERVE SHED T.O.F.=105.5 FINISH GRADE TO SERVE AS AN INSPECTION MANHOLE. EXISTING F.G. EL.=102.Ot F.G. EL.=103.$t O� " F.G. EL.=102.8 CHARCOAL VENT DECK ��1.8—r_ 77 to TM 20.8� I L = 45' L = 17'(MAX) ® S=1% (MIN.) 0 S=1% (MIN.) TINGEX/S �� Q 4'SCH40 PVC 4"SCH40 PVC 6" 2" LAYER OF 1/8" (n HOUSE 14 ®O® TO 1/2 DOUBLE I 14" s' 12" WASHED STONE T.O.F.=105.5f Rj • EXISTING 48" LIQUID INV.=101.5t OR APPROVED FILTER FABRIC) x'� �• 0 LEVEL (VERIFY) PROPOSED INV.=99.20 ' GAS BAFFLE 4 3 4' 3/4"-1 1/2" �" CL I INV.=99.37 � INV.=99.00 EFFECTIVE WIDTH 11 DOUBLE WASHED I I H-20 STONE EXISTING SEPTIC TANK USE 5 LC-6 GALLON LEACHING CHAMBERS IN SERIES WITH 4' OF DOUBLE WASHED STONE—ALL SIDES NOTES: H-20 RATED 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE TOP CONC. ELEV.=99.83 _ INVERTS, PRIOR TO INSTALLATION. INV. ELEV.=99.00 ®®®O E3 E3 E3 ELEV BREAKOUT9. SEPTIC LAYOUT 2) D—BOX SHALL BE SET LEVEL AND TRUE TO ®®®®®® GRADE ON A MECHANICALLY COMPACTED SIX BOTTOM ELEV.=98.00 INCH CRUSHED STONE BASE, AS SPECIFIED IN 4' 5 x 6' = 30' 4' 310 CMR 15.221(2). 4' OF NATURALLY OCCURRING f 4' KNOCKOUT 3) INSTALL INLET & OUTLET TEES AS REQUIRED, PERVIOUS MATERIAL EFFECTIVE LENGTH = 38' 4) GAS BAFFLE TO BE INSTALLED ON OUTLET TEE 5' (MIN.) ABOVE G.W. I so" �� COVER AS MANUFACTURED BY TUF—TITE, ZABEL OR EQUAL. NO GROUNDWATER, EL=92.9 4 LEACHING SYSTEM SECTION 4'KNOCKOUT 4" KNOCKOUT SEPTIC SYSTEM PROFILE ;___ 4"KNOCKOUT J r N.T.S. 72"SOIL LOG I PLAN VIEW. DATE: NOVEMBER 24, 2014 (REF. P#14,580) SOIL EVALUATOR: PETER McENTEE PE, (SE#1542) — E — — DESIGN CRITERIA WITNESS: DONNA MIORANDI R.S. HEALTH AGENT ® ® ® 0 ® ® ® 22" ® ® Elev. TP— 1 Depth Elev. TP—2 Depth INVERT I NUMBER OF BEDROOMS: 2 BEDROOMS, PERMITTED FOR 3 (84-823) 102.9 0„ 103.0 011 12" SOIL TEXTURAL CLASS: CLASS 1 FILL FILL 100.2 32' 101.3 20" r 72" r 36" DESIGN PERCOLATION RATE: <2 MIN/IN A SANDY LOAM ' A SANDY LOAM SIDE VIEW END VIEW DAILY FLOW: 220 GPD 99.6 B 10YR 4/2 40" 100:8 B 10YR 4/2 26„ DESIGN FLOW: 330 GPD SANDY LOAM SANDY LOAM WIGGIN LC-6, H-20 LOADING GARBAGE GRINDER: NO—AND NOT PERMITTED WITH THIS DESIGN 98.4 1OYR 5/4 54" 100.0 10YR 5/4 36„ LEACHING CHAMBER EXISTING SEPTIC TANK: 1000 GALLON CAPACITY C C PERC LEACHING AREA REQUIRED: (330 GPD) = 445.9 SF 30"/48" N.T.S. .74 GPD/SF MED. SAND MED. SAND PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 5 LC-6 GALLON LEACHING CHAMBERS IN SERIES 2.5Y 6/4 2.5Y 6/4 CENTERVILLE, MA WITH 4' OF DOUBLE WASHED STONE-ALL SIDES 14 PENA WAY, SIDEWALL AREA: (11.0' + 38.0') x 2 x 1' = 98.0 SF Prepared for: Capewide Enterprises, 153 Commercial St, Mashpee, MA 02632 BOTTOM AREA: 11.0' x 38.0' = 418.0 SF 92.9 120" 93.0 120" Engineering by: ,, SCALE DRAWN JOB. NO. TOTAL AREA:........................................................... 516.0 SF NO GROUNDWATER OBSERVED Engineering Works, Inc. N.T.S. P.T.M. 116-15 PERC RATE <2 MIN/IN. ("C" HORIZON) 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(516.0 SF) = 381.8 GPD (508) 477-5313 3/2/15 P.T.M. 2 of 2 20 FT. MIN. ' TOP OF FOUND. EL. = 2_?:�scp 10 FT. MIN. CONCRETE 4" SCH. 40 PVC CLEAN SAND COVERS ` PIPE- MIN. PITCH CONCRETE I/a3 PER FT, b" u P • . = COVER r - ° 4'' CAST IRON 12" MAX. 2,� LAYER OF PIPE- MIN. PITCF' '• �� !/8"- 1f2" WASHED'_, -w.. 1/4 PER FT STONE c FLOW LINE 10 r � ...= MIN. EL._ EL.- EL.= t • - - EL.= r DIST. EL= i .� W LOCATION MAP BOX ' _ v n 1«=- 3/4% 1 1/2" 4, w WASHED STONE '�b'° u. o D a` o 0 W d b� GAL. PRECAST LEACHING •a"• � ;_ELz 14.3 BASIN OR EQUIV. SEPTIC 6.0' TANK BOTTOM OF TESL° HOLE OR USGS PROBABLE WATER TABLE EL. = �/ f PROFILE OF GROUND WATER TABLE' 4 'L!c/ +.) EL. SEWAGE DISPOSAL SYSTEM ---�-- 1 NOT TO SCALE ��----- rl� DESIGN CALCULATIONS SOIL TEST -;trpt c- N ' NUMBER OF BEDROOMS .. .. . .. . . . . . . . . . . . . . . . DATE OF SOIL TEST q , .•4�- GARBAGE C3 SPOSAL UNIT.. . . . . . . . . . WITNESSED BY 3.L . I/ TOTAL ESTIMATED FLOW GAL../BR./DAY x =' BR ) .. . . . . . GAL./DAY PERCOLATION RATE=- ,_MIN./INCH REQUIRED ELPTIC TANK CAPACITY L OBSERVATION HOLE I OBSERVATION HOLE 2 h .} ACTUAL S(Z: OF �?EPTIC TANK.... _ GAL. ELEVATION = t' ELEVATION = LEACHING #`REA REQUIREMENTS )odd SIDEWALL AREA GAL./S F. BOTTOM AREA GAL./S.F. TOP `rS a LEACHING CAPACITY ( BOTTOM t SIDEWALL) . t=_.' ' %t' GAL. `4 3 RESERVE LEACHING CAPACITY ...... ... ..... GAL. 'I d' 1 s 3I1 . NOTES All Q \ 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.Q.E. TITLE. S AND THE TOWN OF RULES AND REGULATIONS FOR SUBSURFACE DISPOSAL � -Tiff OF SANITARY SE WAGE 2. ALL COVERS TO SANITARY UNITS SHALL BE BROUGHT TO WITHIN 12" OF FINISHED GRADE. FILE N�� � �k \ � Nv t ` � 3. EXISTING AND FINAL GRADES SHALL REMAIN ESSENTIALLY MIN. FRONT SETBACK --�' THE SAME. MIN. REAR SETBACK t 4. NO DETERMINATION HAS BEEN MADE BY THIS OFFICE AS TO MIN. SIDE SETBACK ry COMPLIANCE WITH TOWN ZONING REGULATIONS. OWNER/APPLICANT t 1 IS TO OBTAIN SUCH DETERMINATION FROM APPROPRIATE AUTHORITY. APPROVED : BOAgD OF HEALTH ` DATE AGENT i PROJECT LOCATION: I FrRICHARID 04t1 Lc)T L Qr_ ;A tIJ� �?,�.R^�i S: L 4ems'`v, . 1r APPLICANT: t ;:P RICHARD� •DAMES~ , ' � 13T��� NO.494HEARN LEGEND V� '�`` �, k - SCALE DR. BY DATE EXISTING 7POT ELEVATIONS OOx0 t_ � EXISTING CONTOUR - -- - - - 00- JOB NO APPD. BY REv. FINAL SPOT ELEVATIONS �Q f" FINAL CONTOUR 04 R. tJ O RIV, Pvc DRAWING SITE PLAN SOIL TES"I LOCATION ! REG. LAND SURVEYORS- RES. SANffARIANS NO. 35 ROUTE 134 -- UNIT 2 50t1TH DENNIS , MASS. OF