Loading...
HomeMy WebLinkAbout0239 PHINNEY'S LANE - Health (2) 239 Phinney's Lane Centei-vil.lc A=230-001 11 i UPC 17534 No.2_153COR '� MASTINOS. UN i I i i Commonwealth of Massachusetts �T Title 5 Official Inspection Form ; . 1. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 'C 239 Phinney's Lane u Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 54 ILI33D on the computer, Brett Hickey use only the tab key to move your Name of Inspector cursor-do not B&B Excavation use the return key. Company Name 374 Route 130 Company Address VQ Sandwich Ma 02563 1k At City/Town State Zip Code rrsi (508)477-0653 S113747 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ❑■ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails Brett Hickey y"`re��yereXH 1-6-2020 =ami wmay.o,ou ama+=on�w�oawmao.am�.��a.pus bmo:mzo.m.os mu:az nsao Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 1 c � Commonwealth of Massachusetts p Title 5 Official 'Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: 0 I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The system was in working order at the time of inspection. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 `I Commonwealth of Massachusetts �1 Title 5 Official Inspection Form ±= Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane V� Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form — Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-20,20 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ O Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 c Commonwealth of Massachusetts �m ,P Title 5 Official Inspection Form + w Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ a Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ❑ El Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ 0 Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ 0 Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ Q Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ a Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ Q The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply I ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts - i,p- Title 5 Official I Ins pection ection Form 71 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No El ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ El Were any of the system components pumped out in the previous two weeks? El ❑ Has the system received normal flows in the previous two week period? ❑ 0 Have large volumes of water been introduced to the system recently or as part of this inspection? Q ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ❑ El Was the facility or dwelling inspected for signs of sewage back up? El ❑ Was the site inspected for signs of break out? El ❑ Were all system components, excluding the SAS, located on site? El ❑ 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? ❑ 0 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: El ❑ Existing information. For example, a plan at the Board of Health. ❑ 0 Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) (310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts �v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane V� Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: 4 4 Number of bedrooms (design): Number of bedrooms(actual): DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 553/GPD Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ff] No Does residence have a water treatment unit? ❑ Yes rol No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No information in this report.) Laundry system inspected? ❑ Yes 0 No Seasonal use? ® Yes [g No Water meter readings, if available (last 2 years usage (gpd)): See below Detail: 2019- 39,000gallons 2018- 59,000gallons Sump pump? ❑ Yes ❑■ No Last date of occupancy: currentDate t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 ti C Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: NA Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Owner- last pumped 3 months ago Was system pumped as part of the inspection? ❑ Yes ❑N No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts �T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u— 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: El Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 12-2-08 per COC Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No 5. Building Sewer(locate on site plan): 2' Depth below grade: feet Material of construction: ❑ cast iron ❑■ 40 PVC ❑ other(explain): Town water Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane V Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank (locate on site plan): 1' Depth below grade: feet Material of construction: ■❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metaIjist age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 2 Dimensions: 000gallons 211 Sludge depth: 3411 Distance from top of sludge to bottom of outlet tee or baffle Scum thickness NS Distance from top of scum to top of outlet tee or baffle NS Distance from bottom of scum to bottom of outlet tee or baffle measured How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): The tank was in working order at the time of inspection. The tank is not in need of pumping at this time but should be pumped every two years for maintenance. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 I i Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): NA Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): NA Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form III.to I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments // 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 0" 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.): The d-box was in workingorder at the time of inspection. p I II I' t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane u Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: (6)3050 infiltrators 0 leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 c � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The SAS was in working order at the time of inspection. Leaching was dry when viewed with no evidence of past back up. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): NA Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 J c Commonwealth of Massachusetts �v Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments I 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): NA Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): .t5insp.doc-rev.7/26/2018 _ Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 N. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is Centerville Ma 02632 1-6-2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: FE1 hand-sketch in the area below ❑ drawing attached separately Assessing As-Built aids -F'(.-.VV N sEwAca_ AS.SY.-.S:,-C)P S N4AP&I',%.RCEI. ,.�. . "^ �' � ,.. IN-S'17 .t.J..ERS N'-_KiJ Bc P11,C)NE NC3. S'EP'rYC'd'ANI{.CA 1AC'1'r'Y ar�L�O b l J AZ l)YNtw 1'AC 21 YIY:(type)��rs S er PR>f-r�/s�^ 7 r' sass t✓ r S � p NO, OF BEOR.C7OMs � _................ .. ......c-._.................... c>wrJx �— t '3 J=' n r PFRMLY n kTE:i C,1-P O S C 03vIT'Z i 1 NC.`4 T3AI F: __- �� ✓' G� Separation r>istance Between the-. i M:axirnusrt Adjusted Grt>undwater-cable tt>the U3 Irtr ni Y_eachi:n�._-Facility ........_..._..__ .............__Fccf; 11rivate'Water Supply Well and L,eachcing Paci.l ty(If any wells exist on site ar witihin 200 feet.of leaching foci.Ii'ty) � feet Edge of Wedsand and I-eaching Facility(if any%vetiancts exist 3 within 300 feet ai'.teacb.ing facility) FUR.NISkiETJ F3cY I i j -S J4,.5 r3—S- its,. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 c Commonwealth of Massachusetts �m Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 239 Phinney's Lane L� Property Address Dimitrios Missios Owner Owner's Name information is required for every Centerville Ma 02632 1-6-2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ■❑ Check Slope ❑■ Surface water X Check cellar ■❑ Shallow wells Estimated depth to high ground water: No GW @ 132" feet Please indicate all methods used to determine the high ground water elevation: El Obtained from system design plans on record Oct-15-2008 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: A plan on file at the local Board of Health was used to determine high groundwater. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form i, — 0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 239 Phinney's Lane Property Address Dimitrios Missios Owner Owner's Name information is required for every Centerville Ma 02632 1-6-2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: Q■ A. Inspector Information: Complete all fields in this section. F0 B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ■❑ C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ■❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinne 's Lane Property Address Linda Fare Owner Owner's Name information is Centerville MA 02632 12/20/11 required for every page. Cityrrown state Zip Code Date of Inspection Inspection results must be submitted on this form.Inspection forms may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information filling out forms i on the computer, use only the tab 1. Inspector. key to move your cursor-do not Michael Kellett. use the return Name of 4sispector key. Aardvark Environmental Inspections Company Name P.O.Box 896 Company Address East Dennis MA 02641: City/Town State Zip Code 508-385-7608 S13742 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 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails C1v ❑ Needs Further Evaluation by the Local Approving Authority j f1 c►1i( 1220/11 Inspecto s Signature Date The system inspector shall'submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage D posal System•Page 1 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form "s Subsurface Sewage Disposal System Form Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220/11 page. Citylrown 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: ® 1 have not found any information which indicates that any of the failure criteria,described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: 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 eAltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 , Y Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/11 page. City/rows state Zip Code Date of Inspection: B. Certification (cons.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with,approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): The system required pumping more than 4 times a year due to broken or obstructedpipe(s).The ❑ Y� �l P P 9 Y system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment.. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated.wetland or a salt marsh t5ins•11f10 Tide 50fttai inspection Form.Subsurface Sewage 01sposai System•Page 3 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments yY. 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/11 page. Cityrrown state Zip Code Date of Inspection: B. Certification (coat.) 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 t of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance:. **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Z Liquid depth in cesspool is less than 6"below invert or available volume is less than day flow t5ins•11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 N, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220/11 page. Cityfrown 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 1.00 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ 0 The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 16.303,therefore the system faits.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems,you must indicate either"yes"or"no"to each of the following,in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface dnnldng,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 Depart<rent. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Flame information is required for every Centerville MA 02632 1MOM 1. page. CitylTown state Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate`yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was,the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner),provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example,a plan at the Board of Health. ® ❑ Determined in the field (f 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on.310 CMR 15.203 (for example: 110 gpd;x#of bedrooms): "0 t5ins-11/10 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220/11 page. Citylrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[i yes separate inspection required] ❑ Yes ® No 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: 09/11 Date Commercialltndustrial 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form a4 Subsurface Sewage Disposal System Forth-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/11. page. Citylrown state Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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) (f 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-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/11 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 12/02/08 per BOH Were sewage odors detected when arriving at the site? ❑. Yes Z No Building Sewer(locate on site plan): Depth below grade: 2.2 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: 1.7 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: 2000 gal Sludge depth: 3" t5ins-11/10 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12120/11 page. Cityrrown 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 29" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle 8„ Distance from bottom of scum to bottom of outlet tee or baffle. 16" 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.): The tank was sound and tight with tees in place and liquid at outlet invert. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑i 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•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/11 page. City/Town State Zip Code Date of Inspection. D. System Information (cunt.) 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•11/10 Title 5 Official inspection Form:Subsurface.Sewage Disposal:System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220111' Page. City/Town State Zip Code Date of Inspection De System Information (cunt.) Distribution Box(d present must be opened)(locate on site plan): Depth of liquid level above outlet invert even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): The box was level and tight with no sign of carryover. Pump Chamber(locate on site plan): Pumps in wonting order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Soil Absorption System (SAS) (locate on site plan,excavation not required): If SAS not located,explain why: t5ins-11110 Tile 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12/20/1.1 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 6 ❑ leaching galleries number: ❑ leaching trenches number, length:. ❑ leaching fields number,dimensions:. ❑ overflow cesspool number: ❑ innovative/altemative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation,etc.): This system has six infiltrators in a 10'x50'field of stone.The infiltrators were dry with no sign of 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•11110 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 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220/11 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.): t51ns-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 7 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 1220/11 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system,including ties to at least two permanent reference landmarks or benchmarks.Locate all wells within 100 feet Locate where public water supply enters the building.Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 4oc,s-Q J, / bo t5ins•11110 Tdle 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 239 Phinney's Lane Property Address. Linda Fare Owner Owner's Name information is required for every Centerville MA 02632 12f20111 page. City(rown State Zip Code Date of Inspection D. System Information (cons) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 20.0 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: USGS maps show an elevation of over 20.0 feet. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•11/10 Trle 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 239 Phinney's Lane Property Address Linda Fare Owner Owner's Name information is Centerville MA 02632 1220/11 required for every page. City/Town State Zip Code Date of inspection E. Report Completeness Checklist ® Inspection Summary:A,B,C,D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information Estimated depth to high groundwater Sketch of Sewage Disposal System either draw n on page 15 or attached in separate file ® 9 P Y P9 P t5ins•1 Ill 0 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 a TOWN OF BARNSTABLE BOARD OF HEALTH ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION � f 5 Date Time: In Out Owner d e11-Z.1L� Tenant Oq ,. Address f Address c- S �vl Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities 6 7. Lighting and Electrical Facilities 8. Ventilation 9. Installation and Maintenance of Facilities 10. Curtailment of Service - - - 1"I-Lt12 11. Space and Use 12. Exits 13. Installation and Maintenance of Structural Elements 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 16. Sewage Disposal L 17. Temporary Housing 18. Driveway Width on 19. Number of Tenants Observed /V PART II 37. Placarding of Condemned Dwelling; Removal of Occupants; Demolition Number of Bedrooms Number of Vehicles Allowed (max) Number of Persons Allowed (max) Person(s) Interviewed Inspector. If Public Building such as Store or Hotel/Motel specify here -�� , yr ace e� n 41,.Q- wain vc v.�-, new. scre ek Id 4ke c,(+u-VN eAn rvva\1 CP-6 r"a&aj C-e VV\ 2-+� nyo-rn OL4 e-& Nvu ail a I Kamk— UkNt 'I" lb - t ,� { t r � � � f �. __,�-_��_-+.-- __ ._. .. __ __. ._ r... -.��...- ._� _�._ mod'. ,.._�-...._. _.,-�.. ter_--. _ �--..- -�-..�-r- _. ..... �, • T �.� .��.y�t��� �}�--�.- -ram.--.-..- ..._._�__-�_�__ � �.. _���� __��.... � ... � __ _��. _ � _.�+- � _. /� � w ,. r..-�n--�.��.��..� � �—`— ��.��� �..1 r� r��� � ���� �� _ �.. ._ ._�� __ r-.--�.._—ram__ram. � � -r+� �r s ,A \ 4 _ �� AsBuilt Page 1 of 1 TOWN OF BARNSTABLE LOCATION �-3Cj Ah#/1 nnni' �-`)'� SEWAGE 0-0 'J VILLAGE C "I ASSESSOR'S MAP&PARCEL a 3 U —OQ J INSTALLERS NAME&PHONE NO. 1711 C.,n SEPTIC TANK CAPACITY6 LEACHING FACILITY:(type) 6"90541 PNFr�`T�til?^� (size) NO,OF BEDROOMS 4 � OWNER PERMIT DATE: I G 1 X10 COMPLIANCE DATE: Separation Distance Between the: Maximum.Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY MAr#J v A—?-" 57` yy-3 r 431 s 13 http://issgl2/intranet/propdata/prebuilt.aspx?mappar=230001&seq=2 6/13/2012 FumM ,: down cape engineering inc FAX NO. : 15083629880 Dec. 04 2008 10:14AM P1 aTS °rawll'll of Barnstable Regulatory Senices `Qbnmms F. G`eilen°, Director r 0MHNKI'filsu_F , • Thomas McKean, Dit>rccatr>"r f+ 2000116q}anon Sd.r�°r',�Tyminis,NU 02601 a f:. Office: 508-862-•1fi/f F lax: SUS-790�C?:''1 k0c0 < / �ew�l;ar.A°�^arrrt�et# ��f1�asA;s�aflr's 1®'I�p�eare�:i 3.j e IS g;g �.ddre•ss. � �`�Cc1ik U� Address: 'A j f On was issued a pertnit to Install a f :,.; ate) (installer) ' ' . Septic st.er n yet � 11 r da � hasecl orf a design dea.wn.by 3 S� Y 0W v'_ �Al r qg¢ ^ . clatcil �C 3 } (cies�.gner) 1: ee'rtif-y that the septic system.referenced above was installed substaritial.ly -,according to the design, wlaieh gray include niuior approved changes sucli as lateral relocation of the distribution box and/car septic tank. 1 certify that the septic system referenced above was installed with '_major changes (i.e. gl'eater than 10' Lateral relcacaiciri of the SAS or any verkicc4i relocation of any com.ponenl z ` of the sepfiic sysic art) but. in. accordance with State & Local Regutations_ Plan r(wision or cea•ti.fecl�tv-built by cicsigt).er to lb1low. ARNE H. OJALA (TI-I.st allerts Siglt:a:tur-e) CIVIL N Flo. 30792 rDcsig.a_-z s Si r t re) (_affix Designer's Stanip Hcrc,) z � .TC ll��A>,^ 1.d )aVT�g��. CER�d1dA' F ,EASE, la �. VI.N TO � aNS1ABLE PU �OF - - 4rQMLr.9J41V,•1F WILL N0'Y BF ISSUED UNTIL 9.60111 `l<IUS FQJZM AND C:.ii1RD dA9t9: laj?Q;CI�{Tkl71y �'kLL, BfUIl�I, � .EPUBLIC91E @.'4'ttR)y�ISS ®JV,_'Ai /AI�IKYODkJ. ` -- -- - k!5iV i } i;!:Fxc;:�J.li3/Sci,tic/9)esigncr(:c:rf.i.iicr,Y.ion Dorm 3-26-04-,1c,c f'fJt,:,'�(10L,in r_.cpe engineering inc FAX NO. : 15083629880 Dec. 04 200E 10: 14AM P2 fif 17 LxoS11NG Fr DWELLING TOP FNDN y k ELF-V. 48.14' #`( DECK \ i 1 r 7,4 rq l: 1 F d �I DO P / PAVED r DRIVE 4 J f \ ��• 1 . e ,,< \ VENT 'I EIR 1 r rS GROVE OF \_ _ TREE'; •' r�i 2 ti Y f�a 08-143 IT T lu :.;i LANE, CEN' ERVILLE I s l.. :�ri � PREPARED FOR: •I, 20° ©ATE 12-04-2008 230 PARCEL 1 IF AR gE�Of Mq < NF H. cry I';,I d t •;I off nos-362 d641 No. 1Ei,,18. \, s T � z� tux SOB—SG'c-86P6 '� r'� civil engineers ` y � U `_ lone se ®yors ' _, ` ' r9 wrain srr�Ps are 6A) DATE REG. LAND SURVEYOR Y.9rMC307HPPR7- ALA 02675 1,' .maao:.a.a S t }{99a V TOWN OF BARNSTABLE LOCATION pil i Yl n'L� '' f_may- SEWAGE# VJLLAGE ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 1`-1► SEPTIC TANK CAPACITY '5(06,0 LEACHING FACILITY:(type) (p -905-0 tV'*L7??-477""K- ,.(size) /O oS X Y9,6 X a� NO. OF BEDROOMS q OWNER I— �h el F—el PERMIT DATE: f V 124 0 COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY � i1/19c N r� Owl A-2" 57" A— — rfoo5 13--S^Ib®' 1 f r � � No. ZG,O� 'y l, d 0 — THE COMMONWEALTH OF MASSACHIlSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARN STABLE, MASSACHUSETTS es ZippYication for 33igozar �§pgtem Cougtrurtton Verm tt Application for a Permit to Construct( ) Repair(✓Upgrade( ) Abandon( ) ❑ Complete System ❑Individual Components Location Address or Lot No. 6*Z 5 / h 1 4 49-fb L--" Owner's Name,Address,and Tel.No. C�s'odsr-eir"� Lr�heG9 Jz 4r^,p Assessor's Map/Parcel r, vh f Installer's Name,Address,and Tel.No. (Z!l4 S&W—+-4/1 C--j Designer's Name,Address and Tel.No. .p+cs—3 3 /eH0_re A4_r 2-4 Ye lea d 7 ``" �• r e 2° �i 3j yr Yt s"� Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) Ny gpd Design flow provided 5 gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank 14 o0 4 a b rrvl ac h Qa/1� CCvj-?0 of S.A.S. 6 0 �.F�/JrA 'r13 4A Description of Soil S-er Sea'l 1cc1 �" "�'c 3•f s,�.� Nature of Repairs or Alterations(Answer when applicable) Sep S'.e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore escribed on-site sewage disposal system in accordance with the provisions of Title 5 of the Environme Code and not to place th ystem in operation until a Certificate of Compliance has been issued by this B rd of Health. Signed �:v , Date Application Approved by Date l0 Application Disapproved b Date for the following reasons Permit No. 0 0 0O— y/ Date Issued `� 2/ 20 0,5 No. ZC;%G �I fi fr -- yMM �. 1 Fee THE,COMMONWEALTH'OF MASSACHUSETTS . Entered in computer: _ PUBLIC-HEALTH DIVISION:J TOWN OF BARN TABLE MAISACHUS.ETTS- r 1rYCottgtrutior eruttZIppritation fo e Yes Application for a Permit to Constructs( ) Repair(Upgrade'( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. "Q S �O h i q h,,'e., '/ 61" Owner's Name,Address,and Tel.No. -- Assessor's Map/Parcel je cr 0 of {r c•dD 3 S S , , h /en /( /q v 13 C Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel,No. .V C. 3 J �rn. �Q ��✓ erg •e-P:Y'�- Ci3y' S)- /A' Type of Building:: V "� ✓ ' Dwelling No.of Bedrooms L� Lot Size sq. ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) //1-/6 gpd Design flow provided 5. 3 gpd Plan Date Number of sheets Revision Date /U- 1 S'"zOos Title J 5� '`j Size of Septic Tank IN�U;a,j«t'�1 G, ^�14./':'"' GfSTYlPofS.A.S. lI -ao 3cS0 Description of Soil `� �'r c `"'` rr' n c 3•f 51 3 Nature of Repairs or Alterations(Answer when applicable) ;/;, _, rJ; y , e ✓ . 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 EnvironmentaLCode and not to place th system in operation until a Certificate of Compliance has been issued by this Board of Health. • Signed ��.+—^— � --- � Date Y / Application Approved by r �. Y- ( Date /D Application Disapproved b Date _ for the following reasons Permit No. fi G/ S Date Issued Z/ ZO 0,5 4 THE COMMONWEALTH OF MASSACHUSETTS - BARNSTABLE,MASSACHUSETTS (Certificate of (Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal System Constructed ( ) Repaired ( ✓) Upgraded ( ) Abandoned( )by at A3cl y9 h)oil-e�2, Lc-,A ( (�,; Fn r v, ► has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z Uo S- y/ dated /G A WP O r'j Installer is (Cr.r C Designer 1a�,. .� �...: e #bedrooms G/ Approved design flow gpd + The issuance of this permit s iall n)t be construed a a guarantee that the systetn ll� ti&nassigned. Date g" Inspector t`-- •--^_' — No. _2-,-->o,,E ` `7 /S— Fee THE COMMONWEALTH e LTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Migo!5at �bpgtcm Comotruction Permit Permission is hereby granted to Construct ( ) Repair ( ✓) Upgrade ( ) Abandon ( ) 4 System located at 3 /'h n ti Lam,o f C p,, 1 M a and as described in the above Application for Disposal System Construction,Permit.The applicant.recognizes his/her duty i' to comply with Title S and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. / _ ��� ► Date Approved by t FROM :down cape engineering inc FAX NO. ;150936298M Dec. 04 2008 10:16AM P1 _ Town of Barnstable , Regulatory Services Thomas F. Cveiler,Dircetor MAN{► eAiKAUarus' = Y'Oblic health Division . z6gg. ° Thomas McKenu,]Director 1 200 Main Street,Hyannis,IVIA 02601 OiTioc: 508-962.4644: Fax: 508-790-6304 Installer&Designer Certification Form Date: la '�` d�' ' Sew-age Per¢uit# 01008-- �i Ayx .,4nr's Man\Parccl 9 0 ! I�e8ASAAcr: v� e �AIrk0hrt Installer: Ellis 2-3 Address: Address: _ P�� Re'� On was issued a permit to install a (installer) septic system at ^rV UIP LAW, _ based on a design drawn by (,addt as) i nun dated /0 la 08 (designer) I certify that the septic system referenced above was installed substantially accordit4 to Cal the dcsngn, which may include minor approved changes such as Literal relocat,ioo of the distribution tx)x and/or septic tank. J� I c urlify that the septic system refmonced above wss inMaUed with major changes (i.e. K•Gutex.1W11 :lA' latuial ieloultiu„ orate S,A,ti or auy YvAicial rcluctidon of any cumpuncnt of the septic system) but in accordance with State &Local Regulations. Flan revisit+n(1r cr rtified as-built by designer to follow. `SH OF Mqs� ARNE H. cyc OJALA (Installer's Signature) CIVIL y _ No.30792 ti \ p�.oSFG/5TEpaO�4' esrgn�r s m ire) (Affix Designer's Stamp IIere) PI,FASM 14U;' 'I)JRN '*0 BARNSTASLE P U(., 10-Al.'1'li DI'V1-814N (-EW19FW.-A-Me 0 COMrLIAIVCtr WILL NOT RF LS.SUM) T)N U— BOTH THL9 FORM AND AS-BUILT CARD ARF RECEIVED AX IM BARNSTABLF PUBLIC HEALTH ORM-10N. THANK YOU Q:liealth/SeVidUcsiancr CcwUtuttim Fumt 3-2Cr0A sloe s FROM :down cape engineering inc FAX NO. 15083629880 Dec. 04 2008 10:16AM P2 E)OVING OWEUJNG \ TOP FNDN EMY. = 48.14' DECK xJ, 5_ r 'l. PAVED DRIVE: �jsa rJ I l i `\ O EXISrNG i \ VENT GARAGE \ /W/ t 9R \ / e \ y GROVE Of \ .l TRUS SEPT IC AS-BUILT a$-,43 LOCATION 239 PAfINNEYS LANE,CENnRVIUE SCALE : a = 20' DATE : 12-04-2008 PREPARED FOR: REFERENCE MAP 230 PARCEL ) L A FARE AR NEE I H. - O JAIA No 28346 �. ro•soo-�e�Leo d*Wnc0ftd.00 n a r•� wA n�i 1#414410film Or. c v// v veers � ;and sfZrl r.S , - 9.39 main Stmal (Rtw 6A) rARMOUT pORV MA n�sxs DATE REG. LAND SURVEYOR 10/20/2008 13:53 FAX 5087710722 BOUDREAU AND BOUDREAU 16002 U 9 Bk 23221--'. I IFj 2 OF RESTRICTION I, Linda I,J:ALc—(JZ_ wmicy's Lane, Centerville, Massachusetts 02032, being Ilic owner ol ol oll a Ilan of land recorded with the Barnstable County Registry of F Deeds in Plait Hook 2(i31, Page )I (the"Premises"),hereby imposes the 1,611mving.restriction upon the Prenii.�cs, NvIlich said restriction shall run with the land and be binding Lipon my successors and assigns thurclo.. TlIc structures ci.)jistnicted or placed upon the Premises shall contain no 1110re th lour(4)1) bedTOOMS in The aggregate unless and until the Board of Health of the Town 01'Barnstable perrili s otherwise, PropertyAddress: 239 Phinney's Lane,Centerville, Massachusetts 1:or title, see deed recorded with the Barnstable County Registry of Deeds in Book 9544, Page 288. WITNE.SS My liand and seal this (::Y;' day of October, 2008- Linda L.Fare COMMONWEALTH OF MASSACHUSETTS Barnstable. ss. (h1 this clay ol'October, 2008,before me,the undersigned notary public, personally appeared Linda-E—. N,ire.proved to me through satisfactory evidence of identification, which was to be the person whose name is signed on the preceding or attached docurnent. and acknowledged to me that she signed it voluntarily for its stated purpose. dreau 7 Notary Public NoterY publicpublicphlop MI&,,.ei i3ou �91 2011 My Commission Expires; - tAll comri),,--Ion Expires Janua-1 28. GornmonweaWl 01 10/20/2008 13:53 FAX 5087710722 , BOUDREAU AND BOUDREAU Q 001 BOUDREAU AND BOUDREAU, LLP Attomeys at Law 396 NORTH STREET HYANNIS, MASSACHUSETTS 02601 Philip Michael Boudreau Telephone:(508)775-1085 Mark H.Boudreau Telefox:(508)771-0722 E-MAIL:phil t@boudresulew_net VIA TELEIFAX Note: A hard copy of this letter is_is not x to follow via the U.S. Postal Service. To: Sharon Telefax: (508) 362-6266 From: Philip Michael Boudreau, Esq. Date: October 20,2008 Re: Linda Fore 239 Phinney's Lane, Centerville,MA 02632 Total Pages: 2 Dear Sharon.- Linda Pare requested that I fax you a copy of the deed restriction recorded against her property this date. If you have any questions or need anything further,please let me know, Sincerely, Philip Michael Boudreau PMB/hcg Enclosure g a TUB 11,16 FAg 6073349-097 William Andrea Inc, �oa5/oa5 ZU �OCT 21 tis10 2 l- u pfp et 9- F �►� ce 1-7 aj f . y . " rn 9 - o c.o w .p. 1111 [ fill a \ Lti 5 ---' X-06� f OECD ,last �czcc�v tioT Co t¢o � . . CO 0 .003/005 TUE.11.15 FAX 607339097 Gilliam Andrei Inc, RON ( r 6k�� l J C7 0 . v ,�pocn j T(IE.11;15 FAX 6073349097 William Andrew Inc, Z002/005 F g5 , w ' S42 4 4'20"W 14 i 0' cr,:- -_c3, LOTj=__c� l7 6_ v LOT S: w L=76:50' —'- �N42 44'20E 117.54.' PHIN EY".1- LANE �1 10:179 Ellis Brothers 508-362-6266 p.?_ engineering inc FAX Iv"D. :15083629880 Dac. 34 2003 10:16AM P-1 R e latary Services Thomas F. Geilee•,T)irca:tna• ;., , `, till • �Q� y (Ali[cc' 5t3E-962-4644 Fan: 508-740-6304 Isastsailer& Demikaaer Certification Form 1 I, ji: Date- ���� �c� Sewn ;e Permit# 01QQ�r— �� s��ax�v�na'o llitial�l�'xirccl 4 I { 1 F� ct.r Address:1 r i� ill Address: i y 1 A. , U �n �:)ai --- — - _. .. was issued a permit to install a (cilaEt ) (installer) Scpuc sys-temutQ __. . .. based on a design drawn by ( d Gs) EA ' ,f� (de�a�rterj �,j • � 1 1 cutify that the Gegreic gystean.referenced above was installed substantially according to U10 (10w29t, WhaC11 tray Include u=or appTovud changes Such as lideral relocation o.t the di!;t6butinn 1-m)x mid/ar septic tank. ' aa`': m I uux.14Y dial: IC, septic system refdonced aafxwe wRs .lilst,91fed with major chauges (i.o, a;s„ a :tc.{: I�,�.F, 10' iatuta] ac110%;ulivaa (If tl.>.e SIAS ur away vurticaal ruloum Lion of an cunipuuunt ti 3 4 ` : of the sciatic system) but in acordaucc with Mate &L) aal Reguiatisans. Plana revi.%)u ajr cerlii5ed a.s-built by desipct to fiulluw. F �a i gt10f A,� 4F1ARNE H. . OJA A Q' �( �.�t�llabf'S 4gEF.it3a£�) CIVIL � � tl sl 'Sr z�ft �` Wit?:, 'r�Fsleers,si ase) . F (Affix.J�esig n.a r'.A Staarap�Ilene) 77t1J e11RL9Dr� �® 9P q ____ � ;1 itQa l'e� 3r��e��T ��, i�Ua$C.ld_ 9�a;�t.:.Cl6 e�.l�lw.rON. d:s,.aa n aN.�e:�:i U tl�+ "A DWTLIA CY, .& NOT RF MSHT sa 117Fq'1 . API TWS FORM .AM) A,�ktt1�€,T �'�.� .ARF q, ,4 h5t'19 R '.1 3AI� ���E.F FPi?DiI.TC . ./iT.I 1C�T)T § 'Oi�I. TJ1. NC Yf31F i - -- — ' a f + A. ��.:�� :�111.�Y SCISBIC��4iS1nliG.1*'f•F�i:rarnli�ssi F`xw��_jtiflA.I.,r• _ uw Page 1 of 1 Cabot, Jaime From: ELLISBROTHERS@comcast.net Sent: Wednesday, September 24, 2008 11:31 AM To: Cabot, Jaime Subject: 239 Phinney lane, centervillle Hi I talked to the home owner today and was told in 1997 (permit number 24890 8/8/1997) she had to pull a permit to remove the gas line in the garage to make the building "not an apartment". " the zoning people told her to do this" She used to us the space as a work loft. she will fax over a copes of info on Thursday to our office and Friday AM I will get it over to you. I hope this helps about the bath room in the garage area. Also she said "the bath room was there when all this came about and is hooked up to the septic system that is in use at this time". The septic inspection was completed because of the house going on the market but she has owned the property from 1988. She received a letter from the town to up grade her system and that is why she is trying to comply with what was asked of her. The copy of the of the floor plans she sent over has a page with the shape of the property building on it. This lists the garage as a GAR-APT. Is this what is in the town records ? Plus I was told "the room listed as a child bed room has low sloping ceilings and play room behind it could be hard for a tall person to stand up in". Sharon Ellis Ellis Bros Const. 9/24/2008 f of c_ Certificate# 09 - 2806 `'"�' Town of Barnstable Fee Paid: $90.00 1 i+I RA WN,-TABLE, �- 'if)" Regulatory Services Department - Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO 2009 CERTIFICATE of REGISTRATION Property Location:239 Phinnev's Lane Centerville MA 02632- Owner's Name: Fare,Linda Owner's Address 355 Winton Road Sherburne NY 13460- Owner's Representative's Name (If Applicable) Sheaffer, Sandra Address: Telephone Number: (508) 775-8409 Number of Rental Units On This Property 1 Number of Bedrooms Authorized: 1 Maximum Number of Motor Vehicles Authorized outside of Buildings Overnight: 2 Maximum Number of Occupants Authorized (occupants under 22 years of age are exempt) 2 2/26/2009 12/31/2009 -::�: o/0�� Date Issued: Expiration Date Thomas A.McKean,R.S.Director of Public Health *This certificate must be conspicuously posted within such dwelling or portion of dwelling* TOWN OF BARNSTABLE // BOARD OF HEALTH Approved: 2 Zw 0� NiLD Cert. jj ARTICLE II: MINIMUM STANDARDS FOR HUMAN HABITATION Date /2,61 Z®dj Time: In /D,zlFO Out /!i"/0 Owner. �-o ��`�. Tenant Address 14N-A L�j ILAV-JC— Address `L 3� t' �► �1�Yt. j tyf— tt<L-e, \-e� 6"3 z �'(�,�� ►�try 6 Z fo Z �'1�i t_.. � 1 -r v t�l �• ���� i3�f fob Compliance Remarks or Regulation# Yes NO Recommendations 2. Kitchen Facilities -rU � �7YJE 3. Bathroom Facilities 4. Water Supply 5. Hot Water Facilities 6. Heating Facilities ✓ N�,� Ci.v "vt iw I�Lf 7. Lighting and Electrical Facilities c� 8. Ventilation 1/ 9. Installation and Maintenance of Facilities 10. Curtailment of Service 11. Space and Use 12. Exits yr 13. Installation and Maintenance of Structural Elements v 14. Insects and Rodents 15. Garbage and Rubbish Storage and Disposal 7 i C k v G� 16. Sewage Disposal V Q-L C- 17. Temporary Housing A//1 18. Driveway Width 19. Number of Tenants Observed PART II 37. Placarding of Condemned Dwelling; 4" L Removal of Occupants; Demolition ih 0 5-.f f-D Number of Bedrooms V K S Number of Vehicles Allowed (max) 2- Number of Persons Allowed (max) ,y/) "L Person(s) Interviewed Inspector If Public Building such as Store or Hotel/Motel specify here 09/23/2008, TUE 11:16 FAX 6073349097 William Andrew Inc, . ?005/005 32- y o Ct 1 F-Z-ac) ram.. ` ►� Ace sc� Etjr m - -� - -ram s d C c ug C, 9-CO2 13 `t� 44 rn n..V / dg tilt 09/23/2008, TUE 11:16 FAX 6073349097 William Andrew Inc, 2004/005 vet _J W v vu U Ak,0 , r / ;i 7 z r /A 1-h Cr-- 09/23/2008 7UE 11;15 FAX 6073349097 William Andrew Inc, I I z 71fle �Iq .� � I � y J C.Iv�N 09/23/2008. TUE 11:15 FAX 6073349097 William Andrew Inc, 002/005 LOT 4 LOY' 3 S42`44'20"W 147 68' —. i F I� 14, 6 17.. 6' DMT LOT �fiA'.` - �o i .76.51)' N42 44'20"f; 117.54' 09/23/2008- TUE 11:15 FAX 6073349097 William Andrew Inc, Z001/005 73 ( rT o s 6OF 3 3 a -qO t l L 10 1b Poe IFIf SOf—l. L. 2"L 2 Fia w� L � ) 7 7 E Y✓� b v r. G N V if 2�7. v iv ct 2 -To e L V�s L 15,ti G U ti �4 6, 2— ) r;F LO '.�.., A4 4 / N YO v-S 6 2 45 n;ti ti J10 �1 t I 1� 4 t%,Czh cis ti, U . � r La/11,Q( 2-A., fz4,cs�c� PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., CHO Director of Public Health Town of Barnstable a File Edit Tools Help Action-- — - _g Detail�t i Application 21 _ atalicarrt Collect Status 1L 1COMPIETE, &/,ner Department 93-R- BUILDIts1Ca DEP RTfa1ENT r _ FARE, LINDA L C1ase/Derry Prgject/Ac1iwi�x 1434-RESIDE,NTIAtL,ADDITIOWALTERATIO Contractor JPROPERTYOWNE.R lorknow Description 1 RESTORE ILLEGAL 3.FA.I+LILY TO LEGAL 2 FA M. business f Description 2 Partcing/disc Fro Property/Use Mon-Conforming Dates?'Misc Permits pertyProperty _.__. ,, ___ __ ___ _._ ._°Propetty Use Reactivate F __. ' Location 23 - � Unit Existing use 1 MULTIPLE HOUSES ONE PARCEL Must fees � Street JPHINNErS LANE'- zoning SPLT-SPLITZO'-NE Parcel 2SM01 � enema Escrow ., .. -. i Municipality CE.tJT-C=ENTERVILLE Misc Chgs Subdivision/lot -- I - Proposed use 1F30,PETIPLE HOUSES ONE'PARCEL Paymt Between. l and j zoning SET SPLITZONE w Audit History , # memo Location,desc Summ Pemut I I i Copy,r'pp Prerequisites [� Haztd/Restr 23 Names ( Bands Sub-Addrs [ Text 0 Man Review ___ Prior History C�3 Inspections k iolations Revie n+s Open;Items 4'sramings Find Related x. --t]2J_J�E] , klaintain project/activity derail for the current application- OVR � I I p SHE t Town of Barnstable Barn Regulatory Services Department 1 edca j > IIAEtNSTABLE, � nA 9. Public Health Division A'F° A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO September 26, 2008 Linda Fare 355 Winton Road Sherburne NY 13460 Dear Ms. Fare, As per our discussion I have enclosed a sample Deed restriction form. This form needs to be completed and recorded at the Barnstable County Register of Deeds prior to the issuance of the Board of Health Disposal Works Construction Permit. At issue here is the status of the property as being approved for four(4)bedrooms (Permit 79-182) and not five (5) as shown on the Title 5 Site Plan by Down cape Engineering dated July 14, 2008. The steps needed to correct this discrepancy are for Down Cape Engineering to revise the plan to show the correct number of bedrooms Three (3) in the main house and one (1) Bedroom over the garage. To ensure that these requirements are adhered to, the floor plans need to reflect only one bedroom on the second floor of the house and a Four(4) Bedroom deed restriction needs to be recorded for the property. Please do not hesitate to contact me if there any additional information I can provide you with. Sincerely, Jaime Cabot Health Inspector Town of Barnstable Direct(508) 862-4651 Cabot, Jaime From: Cabot, Jaime Sent: Friday, September 26, 2008 9:36 AM To: 'downcape@downcape.com' Subject: 239 Phinneys lane Centerville Hello Dan, I have spoken to Linda Fare concerning her property and she has requested that I speak to you regarding revisions to the site plan (08-143)you have prepared for her. For Your information I have attached my letter to Linda Fare concerning this matter. I 239 Phinney's lane.doc(55 KB)... The revision that needs to be made is a change from a five bedroom design flow to a four bedroom design flow. I believe it would be Ms. Fares option to re-size the system components or to leave the system components as shown on the Plan. Jaime Cabot Health Inspector Town Of Barnstable 1 09/23/2008 TUE 11:16 FAX 6073349097 William Andrew Inc. �005/005 F-4.ao (Z--- 'D(v i.LL . Q - . -P-h5 ursp G P� C -b A-5'CMe J" F�� F � 09/23/2008 TUE 11:16 FAX 6073349097 William Andrew Inc, 2004/005 . J ly 4 N w /oo . A8ov;e h s • 09/23/2008 TUE il:15 FAX 6073349097 William Andrew Inc 23 -FA/k , �+ ,- NT- /• (�7f q Z) C, V 7 �D • 09/23/2008 TUE 11:15 FAX 6073349097 William Andrew Inc, 2002/005 i LOT 4 LOY' 3 S42 4 4'20"W 14 7.68' -. i 14.� 0' LOT LOT ,� - - W22 4' 19 f-� 2 _Af'T i L=76.50' ^N42 44'20"F 117.54 PHINNEY'k- LANE 09/23/2008 TUE 11:15 FAX 6073349097 William Andrew Inc. 001/005 � 1 ( is n Co Sb 3 6D- 959 0. � 7 I _ TOWN OF BARNSTABLE LG+�ATION oZ3q' EL��--Id �Ix� SEWAGE # VJ.LAGE �� � ASSESSOR'SS�VAP & LOT,7Zk DO/ SEPgHS T-A iC CAPACITY A4 LEACHING FACILITY: (type) (size) � G NO,OF BEDROOMS B;JffiD9R-QR OWNERa�'z--- PERMITDATE: AC LIANCE DATE: - d Separation Distance Between the: Maximum Adjusted Groundwater Table to the ottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by r Town of Barnstable - oFtNE rqy, do Regulatory Services a Thomas F. Geiler,Director MMSTABM E A•A, Public Health Division Thomas McKean,Director 200 Main Street,Hyannis, MA 02601 Office: 508-862-4644 Fax:. 508-790-6304 October 4, 2006 Ms Linda Fare 355 Winton Road Sherbourne,NY 13460 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,Title 5 The septic system owned by you located 239 Phinney's Lane, Centerville,MA was last inspected July 5t' 2006 by,Brad J. White, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system"Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in hydraulic failure. You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder,please feel free to contact the Barnstable Health Department. F STABLE HEALT DEPARTMENT s A. McKean,R.S., C.H.O. Agent of the Board of Health •°�`NE Town of Barnstable Public Health Division I ti o�P �cF � .sa 200 Main Street , ` �FOMPy� Hyannis, MA 02601 vrr"E" 02 1 A $ 04.s40 " 7005 1160 0000 0191 1741 000asoszss AUGoa zoos MAILED FROM ZIP CODE 02601 Ms Linda Fare 239 Phinneys Lane r$ x �y Centerville, MA, 02632_ - ;- ITT E 977 -,_._ _ _._._ _. ..__�_.._..__ --� � �- FORWARD TIME EXF RTN TO SEND F ARE'LSXNDA 355 WIN TON RD 31-IrROLJRNE NY 1:3460—a.516 RETURN TO `ENDER _ ,: ° �2.8 ' 02 ����eeeeleJe��u��e n eer��e�ee���eee�jreeer�e���ree��eeee�e}e� COMPLETE w ■ Complete items 1,2,and 3.Also complete A. Signature �- item 4 if Restricted Delivery is desired. ❑Agent 0 Print your name and address on the reverse X ❑Addressee so that we Can return the card to you. B. Received by(Printed Name) C. Date of Delivery " ■ Attach this card to the back of the mailpiece, 1 or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item i? ❑Yes If YES,enter delivery address below: ❑No I I i Ms Linda Fare 239.-Phinneys Lane 3. Service Type ❑Certified Mail ❑Express Mail Centerville, MA 02632 , ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. i 4. Restricted Delivery?(Extra Fee) ❑Yes { i 2, Article Number 7005 1160 0000 0191 17 41 (Transfer from service label) PS Form 3811,February 2004 Domestic Return Receipt 102595-02-M-1540 " i ii 4i i! 7 U.S. Postal ServiceTr� fDomestic Mail • T Fl Y OFFICIAL M Postage $ % ��0 C3Certified Fee Return Receipt Fee Postm; O (Endorsement Required) p� () H4 O Restricted Delivery Fee ..D (Endorsement Required) QV -G , Q� r-R Total Postage&Fees $ v5 C3 Sent�To zn or PO Box NO. �- City,Stete,LR+4-PS Form 3800� 6 - --••- - ------- •- •- �� Certified Mail Provides: (as�anay)ZOOZeunp'008£�odSd ■ A mailing receipt ■ A unique identifier for your mailpiece o ■ A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. °For valuables,please consider Insured or Registered Mail. y o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver fqr a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. a For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-Delivery". . e If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an-inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. Town of Barnstable �OFTNE�� do Regulatory Services snxvsrne Thomas F. Geiler, Director MASS. •�� Public Health Division TED MA'S A Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 July 31, 2006 Ms Linda Fare 239 Phinneys Lane Centerville, MA 02632 „ ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5 The septic system owned by you located 239 Phinneys, Centerville,MA,was last inspected on July 5th 2006 by, Antonino Caponiqro, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system has "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: System is in Hydraulic failure You have 2 years from the date of the of the system failure to bring the system intyo compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE HEALTH DEP TMENT Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Ing, r " COMMONWEALTH OF MASSACHUSETTS ExECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ' >i,� ,> », r r t;• a;; b DEPARTMENT OF ENVIRONMENTAL PROTECTION41 R OUP 0 / ♦?� J. rt 07 � 4 TITLE 5 `` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address; 239 Phinneys,Lane ,hY :Centerville,MA.02632 � ,s Owner's Name. Linda Fare .: Owner's-Address: 355 Winton Road Sherburne,NY. 13460 ` Date yof Inspection: 06/21/2006 Name of Inspector. (please print) Brad J White P. k#a a Company Name ,Windriver•Enviromental t; Mailing Address:.107 N.Main Street' Vim. Carver ,MA 02330 Telephone Number: (508)-866-2576 F- wY. 0 ..:, STATEMENT CERTIFICATION �: . I certify that I have personally inspected the sewage disposal system at this address and that the`information reported s;;, '. 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 syste S.I am'a'DEP� '# "A approved'system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The sy tem: .. Passes Conditionally PassesIj n b the Local Approving Authority s a Fails , Inspector's Signature: ' Date: 6/21/2006 <yL The system inspector shall submit a cop this inspection report to the Approving Authority(Board of Health or; a DEP)within 30,days of completing thi ' spection.If the system is a shared system or has a design flow of 10,000 r ` 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. j Notes.and Comments :, System isn hydraulic failure � r This report only describes conditions at the time of inspection and under the conditions of use at that fi time.This inspection does not address how the system will perform in the future under the same or different tt ,js conditions-of use. i , s,a Title 5 Inspection Form 6/15/2000 page 1, � . r. f .. Page 2 of 11 ` OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 239 Phinneys Lane Centerville,MA.02632 Owner: Linda Fare Date of Inspection:/06/21/2006 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. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T;tla 1; Tn —f,'— P— 4/1 G/7M11 2 Page 3 of 11 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 239 Phinneys Lane Centerville,MA.02632 Owner: Linda Fare Date of Inspection: 06/21/2006 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Titic 1;T--t;— 17—A/1 3 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 239 Phinneys Lane Centerville,MA. 02632 Owner: Linda Fare. Date of Inspection: 06/21/2006 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _ _X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool —X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/2 day flow —X— Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ _X_ Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. —X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _Yes_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) 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. Title G 1--t;— P—Ail 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: 239 Phinneys Lane Centerville,MA. 02632 Owner: Linda Fare Date of Inspection: 06/21/2006 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period? _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ 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? _X _ 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 _X_ _ Existing information.For example,a plan at the Board of Health. _X 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)] Titles G Tnc—f;— 411�;i')nnn 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 239 Phinneys Lane Centerville, MA. 02632 Owner: Linda Fare Date of Inspection: 06/21/2006 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440gpd Number of current residents: 1 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no):NO Seasonal use: (yes or no):Yes Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no):NO Last date of occupancy:Current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped after Inspection Was system pumped as part of the inspection(yes or no):Yes If yes,volume pumped:1,000 gallons--How was quantity pumped determined?Sight tube on truck Reason for pumping: check cesspool TYPE OF SYSTEM _ _Septic tank,distribution box,soil absorption system _X_Single cesspool _X_Overflow cesspool Privy No 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: Cesspool is believed to be original and leaching pit is believed to be approx 25 years old. Were sewage odors detected when arriving at the site(yes or no): NO Titles G Tnen 1;4 Pn —Ail 6 I Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 239 Phinneys Lane Centerville,MA.02632 Owner: Linda Fare Date of Inspection: 06/21/2006 BUILDING SEWER(locate on site plan) Depth below grade: 36" Materials of construction:_cast iron 40 PVC other(explain): Distance from private water supply well or suction line:N/A Comments(on condition of joints,venting,evidence of leakage,etc.): Building sewer is in fair SEPTIC TANK: (locate on site plan) Depth below grade: Material of construction: X 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: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): T;rIA Tncnar4;nn .,,,, �ii ci�nnn 7 Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 239 Phinneys Lane Centerville,MA. 02632 Owner: Linda Fare Date of Inspection: 06/21/2006 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Ti410 G Tnenar4inn Pn 4/1 r,0nnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 239 Phinneys Lane Centerville,MA.02632 Owner: Linda Fare Date of Inspection: 06/21/2006 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: Type _X leaching pits,number: 1 @ 6' x 6' level in pit is sitting in the leaching pipe.(2"below grade) 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.): Soil is wet.System is in hydraulic failure vegetation is grass. CESSPOOLS:_X_(cesspool must be pumped as part of inspection)(locate on site plan)cover on surface Number and configuration: 1 Standard Depth—top of liquid to inlet invert:3" Depth of solids layer:2" Depth of scum layer: 4" Dimensions of cesspool:6' x 6' Materials of construction:—Cynderblock Indication of groundwater inflow(yes or no):_NO Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.):_soil is wet.Cesspool is acting as a holding tank. 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.): T;rIP G Tnenar4inn Rnrm till v�nnn 9 drY'"1' i fa;`6£Py} ter✓dt as x t y {t ' n µ Vi t� fgsay t zntgtrts}�♦ 'SY d rf o t'F' I.�4.w. *..' y ° }M •rt { 1 t X k,� Y '{ �'` dLi�"sayi s i7 i +}t1.t4kiS'i�'•sP }( t'�.{ .... I' rt t r t . L ,., lttx .f{ jury tft n* v � " e^'t t! Frk nr. ,ir i k :a, A A'� x# v l*",a" x A+ F,L�,ti N t;Page 10 of 11' ;�, „a�c , . � , , ;r } r .�;t ,,_,r rjy" A;,.. - , x�,, P t:�, ppyk,n ,r1 ray.^a�i� tf''jt-. >, ° _Ar lk bvt .�° f w ,. , ( , , r . 3 t;l 7,, c. fi. YsM. Sfi }11 . '•n', ') br� rtr a.t r i ,� $ .l.;x �" i� FS'.,,i fi nµ•., , I a ; 11 d g x ay67'v{iiI 12 S:til'�v L ,If{, c,i }S r : f e{ ,,r i, . x , ��`' r+t Yi,+ ,i a.:*. -.;I °s �^"$2�it �'"•stp 'f'rM f7 tS'yyr ewsl t 5,�!. ;.fp ):f F� ,s f c,w�L F t.. ,+ 4 .. t.�` V,1 rx1, r yid .'a �t {. , SY,'�\.2v. '+-153 '� r .t u r a y d ' ., ,�3c. CR7,• c .,M`'2" �3 y' °rf t a 4OFFICIAL INSPECTION FORM NOT FOR VOLUNTARY.ASSESSMENTS, { �'m4 �i st ,, i� t'.x ttte it ! 'fk Y,' �j - ,. d ,. ._z n,, t - •e s gt- (�� ,t + ri � fq�� �CUBSURFACE SEWAGE�I�SPOSAL SYSTEM INSPECTION FORM ' 7i � � ` �Q}. _}'}+h''.{{ „{i ^h`. , n.Yr' ..:s. .�:',t �{ J.- !r>t j�•.a.y'+� +,. , .. Rhj f ` F�{f" R'Y't' kt M13"'p't�"' `:.�' "nx .pk P i' d,�< 11 :*i aid' ,.',t sr .�M�k�,a4:.'fa' f , x"yi �f L;t. x e + f•c1. ry r,} L i"ir�'1: b10 t �3, �.) g xa ;'m.. k��"+T"3�,`?, M r <'�-%ta K�.{.,},l,�F31 y,s.�{t ta' ,'sa ,`4i4�, k t :.PART.,,' t t h.. ,�" •r.. .. �u•,g i€x yir g �. !` & LL,; iy°{, '"y' s"',y) ara Yr �11. t- S Y ,� a;,s Y." .:a rt }i g. P > a� r t, ; °'r �, {K w ,SI'STEM INFORMATION;(coritinued) s t , , � , '#' t b pK,7� axa t14.x�'� br i, 9 }'i z{ t + , n ?I t>... ( _-8 ":t (�3,,:.iy1 z .' p 'i tt.t:,Srt,sba Np x§ '�d k; 4i �,.c M +, i' ,hri p tt`4 A _r 3 It ) i...�- tt'xU i s t l�sr ar �9S ykxa } .r .,�a, `� t ry r V :: i 1 a,.._, s , , + { r `• yj'r Yct,Ci .r•a, k�""x S,:d 9>5 )'rt'�',�'vr# titx r,:;x 4t#f a ,V �''; t t c�. -.� r rx i �. x::i .'"F,' pr �, titr, "sfi d�rz r .s§'+ r;:. f ,5 r. a' rlt„ i':?r` a; v"' `'lam t ,+,�«,J�; tProperty�Address ;239 Phinrieys Lane i' t r i ~ a Y =, x "`Vnt�t pu :! ,+#r.Y .M ` 'trkkv`f� s. k{ - ,;F,y a t; r� );. ,N ', r`k X". i)�'" ' ,+ s�aTh a ,Centerville,MA 026 -• - ,, i Y ;art � '= , #Owner Lmga:Fare t t {t 1. 1. I. :, i ;: , c*�r � I yx t s i. 1� a �r ;l Date of Inspection 06/21/2006 r i s �r i t^!ro etc ',� 'rt,5 a y t 5 o, i F`a+r a't x r - 't 1 I€ a^. I. y�y?'y:,.15, ,s i R,��*:i' x v r- >e.. C .. 14 c£� r: t � ".f,,,. 7pr":S'M °: x °, f, (; ,'.s i 4 t } ,g're'. a d h . , +a ' ✓ rf e;. 5f t e y� t t r £,a "'{p.. �¢* �•''.SKETCH`OF;SEWAGE DISPOSAL SYSTEM }, -i ,, Ei js``; Es i,v, ,-, t,� ;: } Y��,.,4 ",r` Provide..9 sketch of the'sewage disposal system'including tiea'to at least two.permanent reference landmarks or, .. F ',kA���Y', Af a't} !, " 'benchmarks Locate all wells-within.I00 feet"Locate where public water su 1 enters the building q° - ' �t ' M w _ p, Pl?y �g e . ,. &r F r r" .,sml x i< x f i ,r x' .£ a 4 .♦ '♦ "ts � j "4 r )@i A Y �i '{r F V y .P _ t C fit t`F i- +' , '.y r r r'fi x,, U. xAK _1 r 1 " _ wY t` *C t r t S Str rF t�r„r '9 ,, 4 e ,r )t :" '' lei'' 5.t G .Y :y 'f5'� y f .i r�r F s , x 1 l} n }}ft {t '',".."Ili." �, :.i yi 1 r, �' '1 } ` - t ,r� � •,r 3. t < > 4r3 s P . ,'yx {1 x.;.� t w s, ,. qxv �� �y f A y2i- r.a 4- t f ray,.j.I.r , + %"1 y 4 ,;. c a: , t� . ., 5 t , �i Yr , i4 €�i ; > t S'*afr ! , y .34. P.,> y :i rid 4 'k , r..+i ( t L t: ,, r. } ,+' #?s t .N r r f £ a s '. `: y 'T' r ir d r r x t r, # c ;;:i? ; r f, x r i �,2`i'...r $h. t✓ . .'. 6 .n tt,r'}9 1 n' f xN ' rk" } 1r , »P ",• ! ,{rc t t �' •0d Y x o t it SK 4�'{ t i� ..y't'A ')•1 4`rf`F 4 4Ye^ :,y Lr�.. _dl Ys rk' a fir. ^.( B r f H�r;k MiL�it"! :� d tii,`T "> F t.'#3 '�, 5y7. 5. •r' s} ,�K A a t .4 r �t* '+� �'1 � i, `••r c� � t ',g d.F,; tF t< 7(4 t k t,.t , [,, � Wt ,4 f �, nt t � r ;: %�`+ .,�;,,'�• ° N'd '¢"1f7'' ' t y"}...c W. } t t rru! ft t i 4 F fy, € tip.., fi �" fy '�.c r Csd �y}i7.K'xir�,,.iifl.ptxyMfz`6f , 'CD' 3°fs`F' t{ }r''1; " - 1 rx a `} ' - ..Vi t _ { ''^+•`L f c. "" !\k �vt t`y '•:y'WSt� t H + t`}yl*s i,+,#xt,4y 'eil ':vi r.�45 1 n �'� t y .-_:t .t'. i, ' i , r r`y+fY �s Fd aiPr ` a Y ✓e, n< _ ,• �Yt is , , t y, «o A} r: 'e"rDras]sk� '{ �. 7�. " k . t�� n (1.1. 9; : ' . , t r-"`k'�,t s , ''.f:, r", ti kF.�a d .x At,k +?fi r����yi�iKr'Vv�l } t,�?x�J aL r Z '.� _ ,t .+ ' ;:, t .�'�`� 'Ytr'�tl L.Aft V, '4` , a # s: 38' `� 41, 4, �fF, 1 } d fi ':} f, f x i,r y r ,} a .+ ?'^ s I it gg h?i,s a V 7 a,r ,+.s tt.^t. b x f' - t l } r}A f ! S, x t w t,, Ys.,n wl i 11 1 ;L e +'S{s•. v .-�s y3 'x. i$41 a.',AX�N, ,!i; r�'�}ytie r;, +, ti }N 0 q ii} i d:. 1 .� i ,:- ",P -;}` s,5T iir4 £„ r#d szr r r !' 1 5 r ;F r ,t,s A x gr Y# �#�& v,*.Y�^�j 2zd t.y 'E<tx`,xys'A`Se:1 Y'' .ir " �,, V. f ja:r a y t "y t•' 4';, "lit''i{"i'a i ill,"i ?i,,"i5p> ,hx7.^'4♦*'k 11{ Yt" 'nt -qt�,x x �';1, a r i ..r u• ., t 4.v r',j ♦ f , `s Tt'� .3. ,'� l r A'yA'',} t.� Y'a�a avr r, i _ - a P r� +p�j,""j N-^' c' tr�ix.:,yr¢'P:�.Y`S j .?2.t y r :♦ d r f t ::�q"J;"k1W �` "F 8 t..V.!�"p rd.Y si:,U'�i<.fi si i i4 + 3 .. ri t' gyp- L. tf {'1i v V s �`'� E U�} �*LrI. 4F r, xl�ria.;: , r �. * k y. y `� t x 1 , t,.' t s 7,:r .''r y7,vs tS i .r" i t r +. } C " +;ka } t `T5 a�, ry'av'1. y :5v ><' '".' cf� ! i,:�.t5" 5 !N+ x 4 ' "' 1 Y i+ ay t i ,".. 5 `zr ifr 5, �,a # +.>r x j ,1Ir+ �� . r.',, ..�� , rt! ,+'.,t, ;,fr .�,'� y.r'.+,a �::j-0;q fur-h +t�t p. ,J:�it e'�,i17, 6 :N }:7� ,,,+,fr : "^ r , 'tL s ,N f +>'' f 5 4' �` .J 3: va R ( 4�: t s"ti,..a $ q 'i4r Sa Rat - �tl+ i.t' a ad Ai aV4 lr,q.'+,,.. x:.6- yr tF2€.'...}a '}'+ _ p r F b s':.x + ; ,,. Yt; ; I 1111, A xi:.r �{ v - a, + .t t_,y G. _& pp s:!+ SIy i,.., xt dx ` � ....;,y3lx,zJ .i list Wr 4{.t°' Y k -1:I.. + I�r Ss .0* t ip.��t .Ft x <,,i s ,^., t a '�. t Y' 1. 4. rr O r r ! r I ,.�'1 i F �' J _r t '�C e 't� ' t _-err . �v.K, S t CI: +:i:' fjn: f'^':���:1 I ''iS' }p} r�" .'C !�v .ify ft 1+.3f x1. N x �-C' +13 ju' .� �.. } 1 \:ndlxy .i r at' a.: _ t i d� s: G41N ''"' r {�"r^y{{ rA §h",j�! "$i P . .ibis{ ..'`w'e t"°��`✓'n')"y�Sta ,' 11'1 f,� ( try �1.,"rti .p y,��7� y, y. f:. "ra.;i /" f 3 ti.� }tx '.�'��s� . 5�17, ;;, V._ ; -,,y'!" ifq fir,,�. ni,jT .i, .) ,`+\p J - f k , r:�k. i 's e k y�Y? kp$k''r.;l y♦, f s r ,y; r ..yC , < � : t. ', r ( v t 3 I c t i t Z— r'a d ,,.. ,x a ♦. t.�.:. i b{ 3, }t(_k,.r t 7 t 't r, t f C�xt \/t > ay *; t e e'+�r' ,i= e r�°' ,'� c + r 4,t rr. �„`. ,` ' t Y' f lts _i7 d�5 f cy?a7 �Y�tr 4•p$trt d f v ft i �+•^rfa :5 4 ., kr i' f Ir"'.t 7;ar ,aB+S ?y}},�i's a ,♦ a 5 tL, i6sy f �Ry' a r r z f k Y$: 7 i ♦1 t r 11 �j, ri r 'x -.y -.art c} YM a�S y A�as'}..t l F, 4 .kv g i; '� '>?ar h,.t 1 Y r'� Y4 c ,r} rc w t�N r kA{< 3 c., + !. c a S �a yt.�. 1 1 - J r �h y F r � t 3 11Vt y � �x xy�+f,rW yir't `. 6•�. .,f,5_,. s q't"ttU f y,sk 7:i r i , _ F L s,_ 5.. v f y 1��.. �� #:. 11,4y d r'7 .z:' s ',! V` k--`tt 7y , k e s v it 9e . t r,, 7 a 0;,w t L { d J x d"t"a P� r 5 u.Y"{i f i r s +1 a r ,k „r. -(a' 4 �. a it ,. 'u V s. ? S W '�"A.'i f' x r-'S*1 }'I i3ct i v�v�4ler q,v t v i' Y J r �'d �`. •i3 ,tll . tin ha f tr}, i. -_ f .,4F. "r< k za 5� P�. xtyeaa { r•s n+w; A,l..,'r:. tiy`fi,arla.. 4yoyy iM ♦ !f y�r�,-`i i t• -r'c .i f. e r F`k us.7�`��f•i #' r�' a x£.-`sk�� rr. t x£.. p °�tr",+J'!'^{^i , +i: w I'Al L:f ,�1P4l�, a F; ,•.... ,r. �� t ttV;,,x t " M t .l F ty k:.r d e, I 1 n �.�i (a' vet k-))y }>�t y a 97 '4 t 1 r.: t ;rr`, rt x S.•' Y }fr..� ; 7¢�( ��iG a r �,4 4J.,^i'� f .'}j { }qK M:�, } Al.i , r,:.5 4 1 . } d i 'k i;.-r'I K iit t'# ,, { 4 W)8 ,r *j, ys�p '�g td ,}�1.L x.: ,t'+..;; ,{. u' `' i sI. } ,*_- F t �(7r,11 wt r'ry Pf F ' ,y,-. l ''� ',, .KI�pp.Q� 'ii n� { r''.ri t�.pt , rr r # ft^^ �,+ »r°^ 4$ {5 , -, { t .1 i '} #'. A c a i" - .3.ks , . ^ e = ,*'xy^d`�`+3 `.JJ 'a. v# .i , ' J .. ,, c s._ p -ais r I (/ter _ xc,,i r. 1. i+*},,Y-- r {' a }7Y r € I Q f : r a :t t r x t 2 �Y,x� - 2 a v }' 'k c r} -fr' I 4i�. ,;v , .'. h } :x,_ 1. � t x S }-° n ,1 i.,.t. x If:Y P`! •.f, � r r J _.t.A t i t" - ;L' :'• r a°t.r n..1 r r 'St i•1 -', �'':k 'f>l r t. t..',r' S i ' r s a '�.'yhF 3 a r zp =t� Tf c #' fi " 'a a a ! s i, c t *t:�y , 5.^,�.., i' r S£.Er.,' 3 S. 5. ,, -.r } ti.j x w r:y -' ". 1 f j r ,� r ty, > t�� y l h 7.S fi5 ,�" Y x s;t + >a Y f:, P$a i F ♦S{r ., t d r - 2 } 41, 1(�°X'}tt"c¢ i f: 11 ?¢ Jr,�yr,at`.:h le ?,4Y 5k {-r r , e: t6 r. ar 4 �', ' Xi W Ap}I A, NE tZ tf '�) i'dr,'.F y, ��G P�iil i1F tt P r ar`r Fi i x r 4 f t 3Ai f�A y x iv J ' 1 r i• f:y J r r e: t i A Z.: 'yr�*-:rr1x at f g t 3Y�„ x r.."#, , r p. ( _I:.• i `'a3� I� `.i•, a 3 `.4 i ,. r nt .`rMul h>.r a i t , 1 11 ", r x '. •F'^ ri c r } 'i, r tail`�a;5 r^v r " P r c � +,r4 h..w t 5a M.it"�- ) i r'�: K r a.,(• - is 'i a r', r: s r �.. t$ o •r t , {.ero 1", i,*:Z+ y¢ nJ� , �.: ,.^ 11� s �h '4� r - , k.;. :3,rx� + " rs 't t ,r '" (lrq btr s. : 1 xra tk., , a _ k r t 'S9; .6ifttWit x; t ' "tl �S e i t,3;, s ; Sw 'Y ZY{.. ,� K�f�)S jF x a {, W } R y� - } i 1 4..j• ` - , § 3• " 4y � ? ! { ," d r > ;�tr ; n'#.t sty ,; -yT r h } ' t. t qyt# rr u k, }' {t t ,\ n ^ i v {t: .:dtt h - i T x x' r , _._.,. 3i .'y nr x :{. itit?r'".'G r .'P t a r, _.' xh c! s x.��ar `' ',..'`Yta .>, .$ +s`{ ^� - t£ Y . '• r'c m t .j r.4.]+rye,k3 ',a :}`.;1',"'37U' h.4. *'i 5+, \ Cr;�y��..7 t 'R�F�1. 'kr`i.'S ., t :Wf `.h w � .7 L S. .y .U,N'71Yu>< .`5f ti Y7 _T s ya..,Xtt . { Tgtla S.'.jna»ant,nntFinrrt /15/711nf1;`# } » : .z�,u k; IQ � "?S Y w r r',y, ,.cL.,F t,s ; ':i'v ,,,i t` t, y.,x.t ,d - }o' s a, x,: ..E3dsaC?vre l�akr F iras �u, aA'.�r t 4s w4� a z iw�Ygr .,:' .x+ z 1}" .r": Jix .,t n r< v;YF�s ae a.wa t}✓:3rS� i4.xr,... ."', I Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM • PART C SYSTEM INFORMATION(continued) Property Address: 239 Phinneys Lane Centerville,MA.02632 Owner: Linda Fare Date of Inspection: 06/21/2006 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 6'+ 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 documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation:No indication of groundwater at 6'. A Title V inspection is often misunderstood to suggest that we are conducting a complete inspection of your system. A Title V inspection is limited to determining if, at the time of the inspection,the existing septic system is functioning. The State of Massachusetts has outlined specific tests that are to be performed,which will be completed during your Title V inspection. However,a Title V inspection, and the inspection that Wind River Environmental is performing hereunder,does not evaluate if the system was installed correctly,has been engineered in accordance with state and local regulations, or whether the system will continue to function in the future. It also { does not evaluate whether the system would meet the past,current,or future Board of Health or State DEP regulations. A system can pass Title V but still not meet state or j local requirements or be suitable for continued use. If the customer would like a complete inspection of their system,including an evaluation as to the design and suitability of your system,Wind River Environmental can provide a quote as to the cost of such services. As well,Wind River Environmental strongly recommends persons interested in buying a home to have a full and complete system evaluation i before purchasing a new home. A new home buyer should not rely on a Title V I inspection in determining if the system will function in the future,and instead should commission a complete system inspection. T;tla c r•,c t;n P,.ri•,411 VIM)n 11 10.CATTON SEWAGE PERMIT NO. V I L L A G " I N S T A LLER'S NAME i ADDRESS BUILDER OR OWNER l�IIZ Serrf DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ?_ �►� r �-- � , �,� � y � .�.���. ._.--_ �� : ~ � - ��. �►�� J h� �.�� ��CPS ' ��+ _�'^ r o R �� R ��r�/� _07f� No ..... ...... Fps....J.. ................ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH rO. ......OF........ ... .....�---------------------------------------------------.. ���0®�' Allp irFation for Dispau al Works Ton.strurtinn Prrutit Application is hereby made for a Permit to Construct ( ) or Repair ( " ) an Individual Sewage Disposal System at: _ ................ ...... ?!4:.... 236--I C �e .... x_..... . ..... ----------------- ---------• L Location-Address or Lot No. ;ype -- ---- ..!----- ....---•-•----------------•--------------- --......---•--------.........s.5.-�2nif...-•-•-----••---•---........-•---.........-•---- r ............. Address --al-ram/ / 1 .................Installer Addressf Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms___---_4...............................Expansion Attic ( ) Garbage Grinder ( ) a Other—Type a ype of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures w Design Flow............................................gallons per person per day. Total daily flow.......................................... _gallons. WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter--.__--_-__----- Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area_____------_--.--:sq. ft. Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by-------------------------------------------------------------------------- Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water............... 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Ri .---•-----••----------------------•--------•----•--------....---------•--............--•-••......--•............................ -------- ---------- 0 Description of Soil......................................................................................................•------------------ x U ••••••••---•---•••--------••••---•---••-------------•-------••-•----••----...........•--•-.....-•-•-----•-.......••---...---•--•--....-•--------•--•-•••••--•---•-------•--••--•......---••-•-••--....._ w U Nature of Repairs or Alterations—Answer when applicable...... T....'..... _7 G.............. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of'ITIL, 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has ben ' sueddb e rd of health. Si e ..... ----•--•--------------------------------•----....•----•...---•--........_ Date Application Approved By........f •---- .... •• . . . -- ....I........................... ............ 7 Date Application Disapproved for the following reasons:.............. -------••------------------•-••-----••----••-•-------• ........................................ ---•--••-•...............••--••-•--•-••-••••-•----•••---•----•••-••---•-----•-•----......--•-••-•----•---••-•-•--...••-••---•--•-•-•-----•-------•-------•--........................................... Date �j Permit No................................. 1..........• - Issued_--Y:7�41.7:7:....--..f.................... No.............. ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............. (7.A6 r'1......OF.... A... ........ ..............:............................... A:pVtiration for Diaposd Works Tonitrnrtion . amit Application is hereby made for a Permit to Construct ( ) or Repair ( t/) an Individual Sewage Disposal System at: , Location-Address or Lot No. t� •................... f . °"................................................ O ner Address Installer Address Dwelling of Bedrooms________ _______ Size Lot____.._..__,___. ,Sq. feet g— .......................Expansion Attic,(( ) Garbage Grinder ( ) aA4 Other.—Type of Building No. of persons............................ Showers — g ---•------------------•-•--- P ( ) Cafeteria ( ) Otherfixtures ------------------------•------•---•------------....----••-•-•••••-•-••---••••- Design Flow............................................gallons per person per day. Total daily flow___....._.....___.._..._.... ``_ W __.....--_-.gallons. 1:4W P 9 capacity g P ;----........ x Disposal Trench—No..................... Width__..___......_._ _ Total Length.................... Total leaching area......_..._.::__.:_.sq. ft. Septic an —Liquid u> ca acrt .__.____._..gallons ., Length Width.__.._.___..__.. Diameter...____..____.._ Depth _ Seepage Pit No..................... Diameter__-....I..___.__..... Depth below inlet......:....._....... Total leaching area......_..._...'� P g t =sq. ft. a Other Distribution box ( ) Dosing,tank ( ,• ) Percolation Test Results Performed bY--••-••-••----•-.••-•..............•----•...............-_-••• ••---• Date-------•----•-----•.._._..-----3•--•---- W •-- Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fs, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ --------------------------------------------------------•--••--•-•-..............-•--------•---......................................................... ODescription of Soil........... --•••••........................••---------•----•._...........----••----•••-•-•••--•••••---•••....•--••••••••----•-••••••---••-............---•-.._....._.. W U Nature of Repairs or Alterations Answer when applicable____'./Ove. � Y's 7.� P•_- 777 y f !/ w; Agreement The undersigned agrees jto install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TIT'.`: 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has been;issued b ..-the board of health. Sine �... .. ....e ........ ---•_-•. ••........ .......•-- •--•-----•- •.......... Date Application Approved BY --•-•--------••-•--------------- ----y- . z.I............. Date Application Disapproved for the following reasons:--••--••-•••• --•••--------•----•••----•-••.._..-••---••-•-••-•-••............• .................... ...._ Date Permit No............... y. --------••-• ........................................ . .. _.:----_---. '" Issued Date i THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH M� 4. Wit? :l.. .. t-Y� OF................ . ........... .....x.......................................... 1F Tatifirate of Tontplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( AT-oi Repaired ( ) by - .............................. --•--- _..._ Instal 04.4 at. �(, �'�,J,;f l 1•.-,..... ��'' 1 i b;.! ,� z -------------------------•-......-•---------- has been installed in accordance with the pr( s of ' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit �' � .�______. _-_ •............... dated-----_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................................................................................ Inspector................................................................................... THE COMMONWEALTH OF MASSACHUSETTS 41, BOARD F HEALTH N y....� _'..... ..j/..�c ..............OF....... .I.................................................... FEE.. .. ........... io �tl ork �onrnr#ion rruti# Permissionis hereby granted.........................:...............•-------••---•---•---••••--•-•••••----•••--•-•••••--••••••-••••••-•••••-••---......_......---..:_._.. to Construct ( ) r Repair (�an Individual Sewage.„Disposal System at i --'���'--tj•-�'� -d-t•--•__7C.4-T'T'j 7J(14.'•:r2--tree:.......... --•.............•------.._.._.._..-------......... -;: as shown on the application for Disposal Works Construction Pnit No _______________ ��// Boarfl of Health Pf DATF:_:_._7::..� .."7 .: ..........................I................. ✓ FORM E1255,HOBBS & WARREN, INC., PUBLISHERS , r LOCATION SEWAGE PERMIT NO. V I L L A G INST1A LLER'S NAME i ADDRESS u B U I L D E R OR OWNER P - l�iS�/PG Serf DATE PERMIT ISSUED � � 1 ��► DAT E .'COMPLIANCE ISSUED '_ �• { -a/n r,Y(/ WINPOW & t2OO? SCNF-I2UL-F- 5YM. MANLF STYLE TYPE KIC"OPENIN6 W.H ANt7EIZ5EN WOOI2W lcHT AGH3050 3'-O"X.5'-0" _ _ - 400 5EIZIE5 POWU3 HUNG - - © ANI?FR5eN WOOt7W06Hr AAN30 O 3-0"X 2-O" 400 5EIZIE5 AWNING O MA50NITF 4 or 6 PANEL 2'-10"X 6'-8" "Y ROOM O MASONITE 4 ar 6 PANEL 2'-6"X 6'-8" O MA50NITE 4 a 6 PANEL 2'-4"X 6'-8" DATE(ZOOM 6 12 LVI, I.ALNPRY DATHVOM Q OSEt ra C LF LIOWN vEMOLi�aoser �' - N ! lll� 6�I�ZOOM 1 - Irp r O C , KFfGF�N = N 6 C 6p 12 DE171200M 3 ' q� 6 71 eHWE� 12 6uAMEv q{q PV C 2) 13/4"x l I/�' LL SGLE I/Y'-I'-O" 0 6KI5TING WA L SeCQNt7 I'LOOIZ PLAN 6 --- 12 �� —71 O Ew5vNz WA-I LIVING ROOM u, PATH MM551N6 ROOM -- Fl CIO" C _ - -- — MA51W DEI7ROOM m (CD L ENTRY - fp j emu: IEN . 0 2 6 12 24 SYSTEM PROFILE ALL SSTEM COMPONENTS SHALL BE NOTES d MARKET WITH MAGNETIC TAPE OR 00 (NOT TO SCALE) COMPAABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT- EL.) �01 0� PROVIDE CONCRETE COVERS WITHIN 6" OF FINISH GRADE PROVIDE 4" INSPECDN PORT TO WITHIN 3" OF FINAL GRADE a OPELFOUND. EL. 48.1' 44.5'LING 2. MUNICIPAL WATER IS EXISTING o N'e eke et A[�D cIANouTS 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. SE SI PLAN FOR LOC. 2� SLOPE REQUIRED OVER SYSTEM 44.0'- 45.0' HOUSE (S) 4. DESIGN LOADING FOR ALL PROPOSED PRECAST aoc (SEE How 2" DOUBLE WAS H�4 krASTOi UNITS TO BE AASHO H-11 �c 4"�SCH40 PVC OR GEOTEXTII E FABRIC 4"OSCH40 PVC PIPES LEVEL 1ST 2' ! 40.3' 5. PIPE JOINTS TO BE MADE WATERTIGHT. 42.3' =1.% MIN. (GARAGE) 0'76' �° i4T i4T 40.51' o V6VITHONSTRUCTION DETAILS TO BE IN ACCORDANCE Peace J� PhinOe�s 1400 GAL } J- L 39.8 310 CMR 15.000 TITLE V. Greot Marsh COMPARTMENT 14" TEE 550 000000000,00 �� 2. ( ) W/ GAS BAFFLE COMPARTMEN GALLON14" TEE '`°+°O�910,0 oZSc� o� 37 $' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND c, W/ GAS BAFFLE 39 97' 39 $� NOT TO BE USED FOR LOT LINE STAKING OR ANY Route 28 fl H-20 3050 INFILTf4TORS OTHER PURPOSE. ocus 00.QooCa.Q i +•° 0040 n O 4 p MECHANICAL COMPACTION & 6" STONE (TYP.) 310 CMR 15.228(1) 3/4" TO 1 1/2" DOUBIE WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. _ 2000 GAL H-10 ST- ACME 12' X 6.5' OR APPROVED EQUAL 9. COMPONENTS NOT TO BE BACKFILLED OR Q OVERALL DIMENSIONS TO OUTSIDE OF STONE: 49.6' X 10.25' , CONCEALED WITHOUT INSPECTION BY BDARD OF 4' LIQUID LEVEL x 11.5' x 6' INTERIOR DIMENSIONS 5 HEALTH AND PERMISSION OBTAINED FROM BOARD MIN. ( 1 OF HEALTH. ( 2 SLOPE) SLOPE) ( 1 9; SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR FROM DWELL. 53' CALLING DIGSAFE (1-888-344-7233) AND LOCUS MAP "M'"A'P SEPTIC TANK 54 D' BOX 2' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & SCALE 1"=2000'f FACILITY BOTTOM TH-1 .& TH-2 9 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF FROM GARAGE - 42' NO GROUNDWATER FOUND 32'8 WORK. ASSESSORS MAP 230 PARCEL 1 11. ANY UNSUITABLE MATERIAL ENCOUNTERED AP DISTRICT *THE INSTALLER SHALL VERIFY THE LOCATIONS OF `ALL SHALL BE REMOVED 5' BENEATH AND AROUND THE SITE IS WITHIN ESTUARINE WATERSHED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PROPOSED LEACHING FACILITY. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR AND REMOVED OR PUMPED AND FILLED WITH CLEAN BY HEALTH INSPECTOR LEGEND SAND. . A 4 BEDROOM DEED RESTRICTION MAY BE PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 99- EXISTING CONTOUR 13 �O� BY THE BOARD OF HEALTH REVISED DURING A PUBLIC '\' REQUIRED BY THE TOWN OF BARNSTABLE HEALTH HEARING HELD ON NOVEMBER 15, 2005 DIVISION PRIOR TO ISSUANCE OF A DISPOSAL X 99.1 EXIST. SPOT ELEV. \ ?7 WORKS CONSTRUCTION PERMIT. � BENCHMARK � FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW 99 PROPOSED CONTOUR /y STEP ELEV GRADE WITH PROPER VENTING (PIPED TO THE ATMOSPHERE 198 4] PROPOSED SPOT EL. ELE = 48.0' AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS \ BE LOCATED MORE THAN FIVE FEET BELOW GRADE. TH1 � GAS E41STING TEST HOLE METER DNELLING \ NOTE: SEPTIC TANK IS NOT DESIGNED FOR VEHICLE 2> SLOPE OF GROUND TOP FNDN LOADING. IF VEHICLE NOTE: SEWER LINE IS ELEV. = 48.14' LOADING EXPECTED, SEPTIC UTILITY POLE SHOWN PER SEPTIC DECK TANK MUST BE H-20. SYSTEM DESIGN. 'AS-BUILT CARD (PERMIT �� y FIRE HYDRANT #79-182). INVERT(S) AND LOCATIONS) MUST BE NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING DETERMINED PRIOR TO ANY C) � LILACS GARBAGE '"DISPOSER _IS -NOT ALLOWED WORK FOR NEW SYSTEM 1 D DESIGN FLOW: 4 BEDROOMS ® 110 GPD = 440 GPD TEST LOGS HOLE L 4S \ \ USE A 440 GPD DESIGN FLOW O � o o r - - - -- �' _ _ _ Q /% SEPTIC TANK: 440 GPD (2) = 880 ENGINEER: DAVID FLAHERTY, R.S., SE2755 LOT 1 C.O. 6 29,329 SFf \ PAVED USE A DUAL COMPARTMENT 2000 GALLON H-10 WITNESS: DONNA MIORANDI, RS DRIVE _ _ � � // 0 SEPTIC TANK (SEE PROFILE) JUNE 30, 2008 I u, ` W o DATE: R , \ \ S° I � �( � � G LEACHING: PERC. RATE _ < 2 MIN/INCH �� I �� �� �� {�' /// SIDES: 2 (49.6 + 10.25) 2 (.74) = 177 GPD CLASS I SOILS P# 12273 C.O. J - - _ �� \\ �� BOTTOM 49.6 x 10.25 (.74) = 376 GPD CP TOTAL: 747 S.F. 553 GPD ELEV. ELEV. INVERT EXISTING ` �� 4 4 EL. 42.3' PAVEMENT s 2?0• v� USE (6) H-20 3050 INFILTRATORS p" 43.8 p° 43.8 CUT FOR LINE ` �' A A TO CESSPOOL �\ TH-z{` �� /% 41100 WITH 3.5' STONE AT ENDS AND 3' AT SIDES GAS \ 3zs LS LS METER , \ 1 OYR 4/2 n 1 OYR 4/2 GARAGE STING29 9' \ H / APPROVED DATE BOARD OF HEALTH MA loll10 W/ 1 BR B B �� \ `\ �` TITLE 5 SITE PLAN LS LS \ \ OF 25" 10YR 5/6 41 7, 25„ 10YR 5/6 41 7, \ �eP� ARE IN VICINITY OF PROPOSED SEPTIC CAUTION: GASLINE AND OVERHEAD WIRES 239 PHINNEYS LANE SYSTEM COMPONENTS G OVE OF \\ �° CENTERVILLE C C TREES PERC PREPARED FOR MS Ms LINDA FARE 2008 1 OYR 6/4 1 OYR 6/4 110. / REV. DATE: 0 TOBER 15, 2008 (#BR'S) � OkAOF/�gs jHOF gss off 508-362-4541 fax 508-362-9880 �- PROP. VENT WITH CHARCOAL FILTER pANiELA. yam o�'� DANIEL 9CtiG downcape.com AND BUGSCREEN (FINAL PLACEMENT BY pJq�, R, s m CONTRACTOR WITH HOMEOWNER A. down co a ea %!leerin h7c. CIVIL N --� p g 132" 32.8' 132" 32.8' CONSULTATION) 02 � NOo.4�� "' � Scale: 1"= 20' / °�F ��s rER� �a� o� �. civil engineers NO GROUNDWATER ENCOUNTERED s S-S ..� land Surveyors 939 Main Street ( Rte 6A) DCE #OS- > 43 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 SYSTEM PROFILE ALL SYSTEM COMPONENTS SHALL BE NOTES MARKET) WITH MAGNETIC TAPE OR o06 (NOT TO SCALE) " a COMPARABLE MEANS FOR FUTURE LOCATION. 1. DATUM IS APPROX. NGVD (GIS SPOT EL.) �0 PROVIDE CONCRETE COVERS WITHIN 6" OF FINISH GRADE Ke�+ PROVIDE 4 INSPECTION PORT TO WITHIN 3" OF FINAL GRADE Wequaquet DWELLING 2. MUNICIPAL WATER IS EXISTING o3 TOP FOUND. EL. 48.1' 44.5 Q Lake qpD 9PPLANrs 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. SEES PLAN FOR LOC. 2% SLOPE REQUIRED OVER SYSTEM 44.0'- 45.0' �, �, HOUSE4. DESIGN LOADING FOR ALL PROPOSED PRECAST NKNOWN (51 2" DOUBLE WASH q PEASTONE UNITS TO BE AASHO H-M (SEE N OR GEOTEXTILE F RIC 4"OSCH40 PVC 4"0SCH40 PVC =1% MIN. PIPES LEVEL 1ST 2' 40.3' S. PIPE JOINTS TO BE MADE WATERTIGHT. 42.3' 0.76 ' 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE (GARAGE) �O aL i aT 40.51' 0 39.8'1400 GAL 310 CMR 15.000 TITLE V.TH Greot Marsh P h n COMPARTMENT �¢• TEE 550 J- o°000°o°o°oo $a ( ) W/ GAS B/�}LE GALLON 14" TEE °° °°°°°° g 2 �0�8 37.8' 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND COMPARTME W GAS BAFFLE 39 97' 39 8' o NOT TO BE USED FOR LOT LINE STAKING OR ANY Route 28 fl oo.Qoo H-20 3050 INFILTRkTORS OTHER PURPOSE. ocus o�dc> ono MECHANICAL COMPACTION & 6" STONE (TYP.) 310 CMR 15.228(1) 3/4" TO 1 1/2" DOUBL= WASHED STONE 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. 2000 GAL H-10 ST- ACME 12' X 6.5' OR APPROVED EQUAL 9. COMPONENTS NOT TO BE BACKFILLED OR OVERALL DIMENSIONS TO OUTSIDE OF STONE: 49.6' X 10.25' CONCEALED WITHOUT INSPECTION BY BOARD OF 4' LIQUID LEVEL x 11.5' x 6' INTERIOR DIMENSIONS 5' HEALTH AND PERMISSION OBTAINED FROM BOARD MIN. OF HEALTH. ( 2 SLOPE) ( 1 % SLOPE) ( 1 % SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR LOCUS MAP FROM DWELL. - 53' CALLING DIGSAFE (1-888-344-7233) AND SEPTIC TANK 54' LEACHING VERIFYING THE LOCATION OF ALL UNDERGROUND & D' BOX 2� FACILITY BOTTOM TH-1 & TH-2 OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF SCALE 1"=2000'f FROM GARAGE 42' NO GROUNDWATER FOUND 32.8 WORK. ASSESSORS MAP 230 PARCEL 1 11. ANY UNSUITABLE MATERIAL ENCOUNTERED AP DISTRICT *THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL �. SHALL BE REMOVED 5' BENEATH AND AROUND THE SITE IS WITHIN ESTUARINE WATERSHED UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS PROPOSED LEACHING FACILITY. PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE 12. EXISTING LEACHING FACILITY SHALL BE PUMPED IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR AND REMOVED OR PUMPED AND FILLED WITH CLEAN BY HEALTH INSPECTOR LEGEND SAND. PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVED 99- EXISTING CONTOUR 1�0� BY THE BOARD OF HEALTH REVISED DURING A PUBLIC X 99. EXIST. SPOT ELEV. HEARING HELD ON NOVEMBER 15. 2005 \ ?2 � BENCHAMRK FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM 99 PROPOSED CONTOUR iy ELEV NTH PROPOSED MORE THAN THREE FEET BELOW STEP NOTE: SEPTIC TANK IS NOT GRADE TH PROPER VENTING (PIPED TO THE ATMOSPHERE) ELEV = 48.0' DESIGNED FOR VEHICLE AND WITH H-20 LOADING, BUT IN NO CASE SHALL THE SAS f9g 4] PROPOSED SPOT EL. \ LOADING EXPECTED,LOADING. IF LSEPTIC BE LOCATED MORE THAN FIVE FEET BELOW GRADE. TH 1 & TANK MUST BE H-20. TEST HOLE GAS EXISTING METER DWG=CLING \ 2> SLOPE OF GROUND TOP FNDN NOTE: SEWER LINE IS DECK ELEV. = 48.14' Q� UTILITY POLE SHOWN PER SEPTIC AS-BUILT CARD (PERMIT SYSTEM DESIGN. FIRE HYDRANT #79-182). INVERT(S) AND LOCATION(S) MUST BE NOTE NOT ALL SYMBOLS MAY APPEAR IN DRAWING DETERMINED PRIOR TO ANY `� LILACS \ GARBAGE DISPOSER IS NOT ALLOWED WORK FOR NEW SYSTEM A{� > DESIGN FLOW: 5 BEDROOMS ® 110 GPD = 550 GPD TEST HOLE LOGS 95 USE A 550 GPD DESIGN FLOW - - - - - - - SEPTIC TANK: 550 GPD (2) = 1100 DAVID FLAHERTY R.S., SE2755 � � - Q6 ENGINEER: LOT 1 � C.O. USE A DUAL COMPARTMENT 2000 GALLON H-10 DONNA MIORANDI RS 29,329 SFf \�� PAVED DE \ WITNESS: � _ - S° , SEPTIC TANK (SEE PROFILE) JUNE 30, 2008 N r Row o DATE: c {' } Rc �� \ LEACHING: PERC. RATE _ < 2 MIN/INCH C)m �� � {`� �// SIDES: 2 (49.6 + 10.25) 2 (.74) = 177 GPD CLASS I SOILS P# 12273 C.O. l - - _ `� �2 BOTTOM 49.6 x 10.25 (.74) = 376 GPD c' CP � >, TOTAL: 747 S.F. 553 GPD INVERT EXISTING" ELEV ELEV. EL. 42.3' PAVEMENT �P ; { 1 s �.0. USE (6) H-20 3050 INFILTRATORS 0 43.8 0 L�v�J 43.8 CUT FOR LINE \ r A A GAS TO CESSPO L \ TH-2(- / P�� WITH 3.5' STONE AT ENDS AND 3' AT SIDES LS LS METER EXISTING 2g.9 \ 'J MA 10" 10" 1OYR 4/2 1OYR 4/2 GARAGE \ H �-1 APPROVED DATE BOARD OF HEALTH 6, W/ 1 BR \ \ B BLS LS TITLE 5 SITE PLAN OF 25„ 10YR 5/6 41 7' 2599 10YR 5/6 CAUTION: GASLINE AND OVERHEAD WIRES 41.7' \ OQP ARE IN VICINITY OF PROPOSED SEPTIC s SYSTEM COMPONENTS 239 PHINNEYS LANE G OVE OF �\� �° CENTERVILLE C C , TREES PERC / PREPARED FOR LINDA FARE MS MS JULY 14, 2008 10YR 6/4 1OYR 6/4 ��jNOFM,gss V,ZNOFMAs off 508-362-4541 PROP. VENT WITH CHARCOAL FILTER �� DANIELA.�c' o���DANIEL s�cy� I fax 508-362-9880 AND BUGSCREEN (FINAL PLACEMENT BY o OJ A downcape.com ALA CONTRACTOR WITH HOMEOWNER CIVIL CI' OJALA N down cope engineering Inc 132" 32.8' 132" 32.8' � CONSULTATION) o.46502 No.40980 • Scale: 1"= 20' jO/ °FS �ISTe ``�� < <�°� SS\0 civil engineers -7�� y R�� land surveyors NO GROUNDWATER ENCOUNTERED ,�( � TONAL EN 9N o� ;� 939 Main Street ( Rte 6A) 08- > 43 0 10 20 30 40 50 FEET DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675