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0059 ROSEMARY LANE - Health
59 Rosemary Lane �± Centerville. f/R A = 147 007006 No. 42101/3 ®RA ji 10% O m O I ' Commonwealth of Massachusetts jq9, 00: - UOCO Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna _ Owner Owner's Name information is required for every Centerville ✓ Ma 02632 7/23/2020 page, Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:out forms A. Inspector Information SL# (4412- fiNlr�out forms on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return —__.._.._ _-- key. Company Name .__.___.�.�__.�._.__.____.__.._ -___ . ,.. . 74 Beldan Lane Company Address Centerville Ma 02632 City/Town state Zip Code raw 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com 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 m training and experience in the proper function p p P Y 9 P pop 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 gr7/2,3/2020 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. tsinsp.doc-rev..712612018 Title s omciai inspection Form:Subsurface Sewage Disposal System-Page t of 15 „. Commonwealth of Massachusetts Title 5 Official Inspection Form 'r► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments __......_ .......... —— - -- 59 Rosemary Lane ........ Property Address Cheryl Caradonna OwnerWorm Owner's Narne required is Centerville Ma 02632 7/23/2020 required for every _._._...__..� .. __. page. City/Town State Zip Code Date of Inspection G. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The property located at 59 Rosemary Ln Centerville is served by a Title V septic system consisting of a 1000 gallon septic tank, distribution box and 3 500 gallon precast leaching chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. __..._ -.....___ _._........_... ................... 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): 151rfsp.doc•rev.712KOI8 Title 5 Official Inspection Fora Subsurface sowaoe Otsposal system•Page 2 of 18 ,4 Commonwealth of Massachusetts Title 5 official Inspection Form _6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments { r, 59 Rosemary Lane Property Address ----- Cheryl Caradonna Owner Owner's Name information is required for every Centerville Ma 02632 7/23/2020 �._._ ---____-. -...-.-- p�• Cd cti yrrown State Zip Code Date of Inspeon -- C. Inspection Summary (coat.) 2) System Conditionally Passes(cunt.): ❑ 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 MO CMR 16.3Q3(1)(b�that the system is not functioning in a manner which will protcct public health, safety and the environment: t5lnsp.doc•rev 7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 16 Commonwealth of Massachusetts f F Title 5 Official Inspection Form 11 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 required for every -- -- pap 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 fall unless the Board of Health (and Public water Supplier, If any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ® ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev 7126010 Title 5 official inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 Commonwealth of Massachusetts -w Title 5 Official Inspection Form --- Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Rosemary Lane Property Address Chet' Caradonna Owner _...._ —._.. Owners Name inforrnabon is Centerville Ma 02632 7/23/2020 required for every _ .._.._.. per, Citylrown _ StaEe Zip Code Date of inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ 0 Liquid depth in cesspool is less than 6" below invert or available volume is less than Ya day flow ® ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ❑ Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ® ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes If the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen Is equal to or less than 6 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of no must be attached to this form.] ® ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply 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 15msp.Bcc•rev.7lMOI8 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of t8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments -; 59 Rosemary Lane _.. Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 required for every ._ page. Clty/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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health i ❑ ® 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? ED ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ❑ ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] Wnsp.doc-rov,7126/2018 Title 5 Official Inspection form:Subsurlace Sawage Disposal Syslem.Page 6 of 10 t Commonwealth of Massachusetts _ ° Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is required for every Centerville Ma 02632 7/23/2020 page. City[Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 16.203 (for example: 110 gpd x#of bedrooms): 330 gpdm_ _ Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes 0 No If yes, discharges to: --- - Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes No Last date of occupancy: current Date 15tnsp.d= rev 712612016 Title 5 Official Inspection Fom Subsuftace sewage Utsposat System•page 1 Of to { Commonwealth of Massachusetts Title 5 Official Inspection Form - e4l Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Gal( Design flow based on 310 CMR 15.203): lons 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: __ __..__________-......_.._._ Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons _T_...._ How was quantity pumped determined? ....... Reason for pumping: t5lnsp.doc-.rev.7lAM18 Title 5 Official Inspection Farm.SUm"ace Sewage Disposal Swam•Pape a of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form =: Subsurface Sewage Disposal System Form-Not for Voluntary Assessments Y 59 Rosemary Lane ` Property Address Cheryl Caradonna Owner Owner's Name -- __ information is Centerville Ma 02632 _ 7/23/2020 required for every ..................... _ page. Citytrown State Zip Code - Date of Inspection D. System Information (cons.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: ,system repaired 2/10/2003 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 1:. feet Material of construction: Q 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,): Joints in good condition, no leakage, vented through roof. t5insp.doc-•rev,7/2 arms Title 5 Official Inspection Form Subsurface$ewage Disposal System-Page 9 of 18 Commonwealth of Massachusetts =F Title 5 Official Inspection Form =� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Rosemary Lane " Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 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 metal, list age: �- - years I, Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons _ 5" Sludge depth: - Distance from top of sludge to bottom of outlet tee or baffle 3' - -- - -- -_-_— 2" 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 10° Flow were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. water level was even with outlet, tank was not leaking and was structurally sound. t5msp.aoc•rev.7r wmla Title 5 Ofttciat inspection Form SuDsustace Sewage Disposal System•Paga 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owners Name information Is Centerville Ma 02632 7/23/2020 required far every _ page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) 7, Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle --.... - - -- -- Date of last pumping: - — Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal Q fiberglass ❑ polyethylene ❑ other(explain): Dimensions: - -- Capacity:. gallons Design Flow:: __._...__.......... __. gallons per day t5visp.dcc•rev.T(OM18 Title 5 Official tnspeclicn Form,Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts _ - FEW` Title 5 Official Inspection Form -- t_► Subsurface Sewage Disposal System Form •Not for Voluntary Assessments 54! ''' 59 Rosemary Lane _. ... , _. .. Property Address Cheryl Caradonna --- Owner owner's Name Information Is Centerville _Ma_ 02632 7/23/2020 required for every _. State Zip Code Date of Inspection page. Cityrrown D. System Information (cont.) & Tight or Holding Tank (cant.) 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): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Distribution box was level and in good condition with no rot. Water level was even with outlet invert with no signs of past backup. t5inV.doe•rev 712MO18 Title 5 Official Inspection Form:Subsurface Sewage 000sal System•Page 12 of 18 Commonwealth of Massachusetts ;- Iy Title 5 Official Inspection Form ° Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 59 Rosemary Lane _.r Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 _ 7/23/2020 required for every ---.__.,�.._._...__.-...---.____.._...T page City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No` Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: 19 leaching chambers number: 3 x 500gal ❑ leaching galleries number — ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: - - ❑ innovative/alternative system Type/name of technology: 15insp dar:•rev 70947.0111 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 10 Commonwealth of Massachusetts x Title 5 Official Inspection Form rl Subsurface Sewage Disposal System Form Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 required for every ----.-- page. CityrTown 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.): s.a.s. consists of 3 precast leaching chambers. Chambers were video inspected from d-box and found with no standing water and a stain line approx 6"from bottom. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -~- Depth—top of liquid to inlet invert _.___.__......_.._._......... Depth of solids layer — Depth of scum layer -- Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): tSinsp doe-rev 712WO18 Title 5 official impaction Farm Subssrraacu Srnvage Oismsat System-Page 14 of 18 Commonwealth of Massachusetts i Title 5 Official Inspection Form of Subsurface Sewage Disposal System Form-Not for Voluntary Assessments . :., 59 Rosemary Lane Property Address Cheryl Caradonna _ Owner Owner's Name information is Centerville Ma 02632 7/23/2020 page. required for every Cit mown p State Zip Code Date of Inspection . D. System Information (coot.) 13. Privy (locate on site plan): Materials of construction: _. _ ........... Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Mnsp.doc•rev.712&2018 Title 5 official inspection Fotm:Subsurface Sewage Disposal System•Page 15 of 18 { Commonwealth of Massachusetts h m_ _ Title 5 Official Inspection Form - — "� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments w 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is required for every Centerville Ma 02632 7/23/2020 page. City/Town State Zip Code Date of Inspection D. System Information (coat.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building, Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately L11j, 61 2 2. t5insp.doc•rev.7/26/2018 Title 5 Official inspection Form.suosurtace sewage Orsposat system•Page is of is • Commonwealth of Massachusetts Title 5 Official Inspection Form 04 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4 �f 59 Rosemary Lane Property Address --- - �� Cheryl Caradonna Owner Owner's(dame information is Centerville Ma 02632 7/23/2020 required for every _.m................-- page. City/Town State Zip Code Date of Inspection D. System Information (coot.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 1 et} 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: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t6msp,doc rev.7QG12010 Tale 5 ofrittai inspection Forth subsurface sewage Disposal system•page 17 of to = Commonwealth of Massachusetts =, Title 5 Official Inspection Form ,=s t� Subsurface Sewage Disposal System Form Not for Voluntary Assessments 59 Rosemary Lane Property Address Cheryl Caradonna Owner Owner's Name information is Centerville Ma 02632 7/23/2020 required for every .___.._._._.....- — - _ page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 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.7012016 Title 5 official inspemion Form'subsurface Setvags otsposat system-Page 1a of 1a Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Michael Kellett cursor-do not Name of Inspector use the return key. Aardvark Environmental Inspection Company Name VkA P.O. BOX 896 Company Address East Dennis MA 02641 'an City/Town State Zip Code 508-385-7608 S13742 Telephone Number License Number B. Certification 1 certify that I have personally inspected the 'sewage disposal system at this address and that:,the ` information reported below is true, accurate and complete as of the time of the inspection.The-inspbi tion was performed based on my training and experience in the proper function and maintenance.-DT on S sewage disposal systems. I am a DEP approved system inspector pursuant to Section M340 of3 Title 5 (310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails K b era -� ❑ Needs Further Evaluation by the Local Approving Authority G� 04/23/10 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. 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 exfiftration 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 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ 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: 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 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. Commonwealth of Massachusetts Title 5 Official Inspection. Form _ Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M °r 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ 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 indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6°below invert or available volume is less than 'h day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is Centerville MA 02632 04/22/10 required for every page. Citylrown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cunt.): Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 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. f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required forCenterville MA 02632 04/22/10 every page. Cityrrown 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? ® El available 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)] Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is Centerville MA 02632 04/22/10 required for every page. City/Town State Zip Code Date of Inspection 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): 440 Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if 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)): Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 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) ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (f known) and source of information: 02/10/03 per BOH Were sewage odors detected when arriving at the site? ❑ Yes 0 No Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 4'M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. CityfTown State Zip Code Date of inspection D. System Information (cunt.) Building Sewer(locate on site plan): Depth below grade: 1.5 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: 1.0 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: 1000 gal Sludge depth: 3" Distance from top of sludge to bottom of outlet tee or baffle 28" Scum thickness 311 Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 16" measured How were dimensions determined? Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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 ❑ 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.): Tight or Holding Tank tank must be pumped at time of inspection) locate on site plan): 9 9 ( P P P ) ( P ) Depth below grade: Material of construction: ❑ concrete 0 metal ❑fiberglass ❑ polyethylene ❑ other(explain): r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened) pocate 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 working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. Cityfrown state Zip Code Date of Inspection D. System Information (cont.) 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: Type: ❑ leaching pits number: ❑ leaching chambers number: ® leaching galleries number: 3 ❑ 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.): The system has three flow diffussors surrounded by three feet of stone.There was no sign of ponding or failure in the stones. i Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 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.): Commonwealth of Massachusetts Title 5 Official Inspection Form Subsu ce Sewage Disposal System Form-Not for Voluntary Assessments 59 Rose�Mary Lane Property Andress Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection D. System Information (.cunt:) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 1 I i -eq Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 59 Rose Mary Lane Property Address Fran McDonald Owner Owner's Name information is required for Centerville MA 02632 04/22/10 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 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 TOWN OF BARNSTABLE LOCATION ®of— SEWAGE # I �O� ASSESSOR'S MAP 6z LOT 1 17 007406 � VILLAGES_ INSTALLER'S NAME PHONE N ?� Z 6 Vt . ii 13 SEPTIC TANK CAPACITY 08c) a LEACHING FACILITY:(type) ��'� C�9 6 e (size, /0 o 1� NO. OF BEDROOMS- PRIVATE WELL OR PUBLIC WATER t�y��/ (As I O BUILDER OR OWNER I I V DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No I i i o � �Q 310 CMR: DEPARTMENT OF ENVIRONMENTAL I I � PROTECTION r! 15.222: continued ` (8) Manholes, with metal frames and covers at grade, shall be provided at the junction of I' two or more sewers,at all sharp changes in direction or a change in>r�`Igrade of the sewers,and at intervals no greater than 100 feet. Where building sewers join lateral sewers or at changes in direction less than 90°and a long radius bend is provided,a cleanout accessible at ground 1, surface may substitute for a manhole.All gravity sewer manholes shall have an open channel depth equal to or greater than the diameter of the inlet sewer and the change of direction in each manhole shall not exceed 901. (Change of direction is the interior angle between the ll new.direction of flaw and the projected extension of the original direction of flow.) (9) The building sewer shall be vented through'the vent stack or main vent of,the building served by it. No trap shall be installed in the building sewer or building drain. (10) All building sewers shall be constructed in accordance with the State Plumbing Code, 248 CMR 2.00. 15.223: Septic Tanks (1) Septic tanks shall have the following capacities: i! (a) For a single family dwelling unit, a minimum effective liquid capacity of 200% of the design flow or a minimum hydraulic detention flow of 48 hours,whichever is greater, shall be required. In no case shall the effective liquid capacity of the tank as measured below the outlet invert elevation be less than 1,500 gallons. (b) When designed to serve facilities other than a single family dwelling unit, and h wenever the calculated design capacity � l I g �is greater than 1,000 gallons per day, a two j compartment tank or two tanks in series which meet(s)the design criteria specified in 310 CMR 15.203 is required. The minimum effective liquid capacity of each tank in series a shall be 200% of the design flow. In no case shall the effective liquid capacity of each tank be less than-1,500 gallons. dl!! (c) When a domestic arba e .g g grinder is proposed or installed, the minimum liquid ! capacity of the septic tank shall be 200% of the design flow with a minimum tank size gallons and-a�two compartment tank or two tanks in'Berries-, all be r utred llj which meet the design criteria specified in 310 CMR 15.223. Domestic garbage grinders II� shall be prohibited in systems which include an elevated septic tank- constructed in !iijl accordance with 310 CMR 15.213 (construction in V-zones). �p (2) The liquid depth of the tank, measured from the outlet tee invert to the tank bottom, shall be a minimum of four feet. A tank with a minimum depth of three feet below the outlet tee invert may be emitted only for Y P y upgrade of existing nonconforming or failed systems, pursuant to 310 CMR 15.404 (local upgrade approvals), where installation of a tank with a l !;� four foot liquid depth is not feasible and shall be pumped on an annual basis with the results submitted to the local approving authority. i�III (3) Tanks which are rectangular in cross-section shall have a minimum inside length towidth ratio of no less than 1.5 to I. Round tanks may be allowed. The inside length of all V�ill i; tanks, measured from the inlet tee to the outlet tee, shall be a minimum of six feet The inside width of the tank shall be a minimum of three feet. Larger length to width ratios are r' preferred. (4) Vertical cylindrical tanks shall have a minimum diameter of five feet. ? (5) Horizontal cylindrical tanks shall have a minimum length of six feet and a minimum width at the liquid surface of three feet. 15.224: Multiple Compartment Tanks Tanks with multiple compartments shall be required as Q specified in 310 CMR 15.223(1). I When multiple compartment tanks are used the following shall be required: The number of compartments shall not exceed two; 3124/95 (Effective 3/31/95) 310 CMR - 518 TOWN OF BARNSTABLE JCATION I�r SEWAGE # Zy63-U 6 �L/-7/ VB:�I':AGE rcw ASSESSOR'S MAP & LOT � � � INSTALLER'S NAME&PHONE NO.e,ff'-c-% SEPTIC TANK CAPACITY /UrJ 6 LEACHING FACILITY: (type) J 1 C`.AQk-"4-V;f(size) `� NO.OF BEDROOMS BUILDER OR OWNER �/�� PERMITDATE: - COMPLIANCE DATE: a63 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 /J on site or within 200 feet of leaching facility) ��1� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) A- Feet Furnished by �C i"c- d/ � l �--e, l Ca ��/'t7 �� t it -'" � III „_�.� �� /�'' �) A ' � A �,�.�-.�I r ]i s�" � \ VV S� ' 1 G®"� \ ,� � � zi -� � � = zG ..-- }� ,� �� _ � ,. ,..�. �. �n �� , . . No. ()0a, Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes � PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS 01pplication for Migotal *p5tem Construction Permit Application for a Permit to Construct( ) epair )Upgrade( )Abandon( ) O Complete System O Individual Components Location Address or Lot No. Owner's Name,Addres and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel N 2 Designer's Name,Address and el.No. Type of Building: Dwelling No.of Bedrooms�� Lot Size C sq. . Garbage Grinder( ) Other Type of Building No.of Perso ft n Showers( ) Cafeteria( ) Other Fixtures Design Flow CJ gallons per day. Calculated daily flow �G gallons. Plan Date Number of sheets Revision ate Title Size of Septic Tank Type of S.A.S. Description of Soil Ci v ? Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Tie5of, a Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued byd e th. SignedDate Lltm It Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued !A, No. THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS ; s' Z(pprication for Migpogal bpgtettt jv5T�I!e tion Permit Application for a Permit to Construct( 6;p, )Upgrade( )Abandon( () O G System El Individual Components Lo ati Address or Lot No.�'"G ��5�•�®� n C Owner's Name Addres"and Tel.1 / Assessor's Map/Parcel / Installer's Name,Address, Tel?,N -` Designer's Name,Address and Tel.No. / d'� Type of Building: /--- Dwelling No.of Bedrooms : � Lot Size �J _6—sq.ft. Garbage Grinder( ) o Other Type of Building No.of Person's Showers( ) Cafeteria( ) Other Fixtures Design Flow j�J c gallons per day. Calculated daily flow �C gallons. _ Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil G ci ? Nature of Repairs or Alterations(Answer when applicable) Date'last inspected: r 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 a Environments Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by o e th. Signed Date Application Approved by Date Application Disapproved for the following reasons Permit No. Date Issued THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of (Compliance THIS IS TO CERYFY, that the On-site Sewage.Disposal rSster Constructed( Repai ed( )Upgraded( ) Abandoned( by �-�'�� '/ /<�' ���C.�' / at r le cr r- has been constructe 'in accordance with the provisions of Title 5 and the foWispopl System Construction Permit No. ZOG.3 ` 3 dated 2 0 3 InstallerL; / A U / 0_/ Designer J '� The issuance o thi permit shall not be construed as a guarantee that the syst ri!i�' f tion as designed. Date 2 b�03 Inspector - No. �.�"— ----------------------�—✓tom Fee THE _.. THE COMMONWEALTH OF MASSACHUSETTS ----�� PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS MiopozaY or- T Conotruction Permit Permission is hereby granted to Constrtjct( )Re air( )Upgrade( )Abandon( ) r_.ta System located at � -P G�2 > � L' and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this-perms Date: I �j Approveo by r i; 310 CMR: DEPARTMENT OF ENVIRONMENTAL PROTECTION hl i II,! 1'! 15.240: continued (c) recharge of the ground-water table with adequately treated effluent with minimal a attendant pollution of the groundwater, and (d) disposal of the effluent without discharge'to the ground surface or the creation of any nuisance. I, (4) The minimum area for the design of a soil absorption system shall be determined by the results of the site evaluation set forth in 310 CMR 15.100 through 15.107 and in accordance '.I. with the.appropriate.long-term acceptance rate cteria specified in 310 CMR 15.242(effluent ri loading rates). Area requirements will be increased by 50% when garbage grinders are installed. `'il, (5) All soil absorption systems designed to serve a single dwelling shall be designed to I I serve a minimum of three bedrooms,unless a deed restriction limiting use to two bedrooms is granted to the local approving authority. ±Il'.il�l (6) Absorption trenches shall be used whenever possible. When trenches cannot be used ?!,I because of area limitations,other soil absorption system configurations may be proposed for substitution. Ijtll� (7), No driveway, parking or iurning area or other impervious area shall be located above Il�j a soil absorption system,except where restrictions on the use of the land make it unavoidable. � l In such cases,the soil absorption system shall be vented to the atmosphere in accordance with j 310 CMR 15.241. (8) The bottom of each soil absorption system shall be excavated to a level grade. If the j removal of stones or boulders is required,creating localized depressions,filling to grade with the excavated soil is acceptable. (9) The soil placed as backfill over the system shall be a minimum of nine inches, II I excluding topsoil, placed in lifts and sufficiently compacted to prevent depressions due to II settling which may intercept or collect surface water runoff above the system. Backfill must I : be clean and free of stones and boulders greater than six inches in size. Tailings, clay or similar materials are prohibited. �j (10) Final cover above the system shall be graded to reduce infiltration of surface water and minimize erosion. Finish grade shall have a minimum slope of 0.02 feet per foot. II (11) Surface drainage shall be directed away from the soil absorption system. Gl`,il 15.241: System Venting l li Systems to be located either in whole or in part under driveways,parking or taming areas s or other areas of impervious material shall be designed to achieve proper venting of the system according to the following criteria: (a) the disposal area distribution system shall be piped to the atmosphere using the same diameter pipe as the distribution system; (b) the vent pipe shall be designed to prevent entrance of animals or precipitation and shall be backfilled tightly to prevent seepage of surface water into the system; pp (c) the vent pipe shall be located beyond the limit of the impervious area subject to I vehicular traffic; �I (d) where trenches,fields or beds are used,the end of each distribution lateral shall be i `i connected to one or more vent(s); (e) where pits are used, the vent shall extend under the cover of the pit; and < i) ,I (f) the riser and above ground components of the vent shall be constructed of durable, non-corrosive materials. ,1 •l•I'II l i 310 CMR -524 3/24/95 (Effective 3/31/95) a CI i Health Complaints 03-Feb-03 Time: 9:00:00 AM Date: 1/31/2003 Complaint Number: 3912 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 59 Street: ROSEMARY LANE Village: CENTERVILLE Assessors Map-Parcel: Complaint Description: SEPTIC SYSTEM WAS CLAIMED TO BE IN p p FAILURE BUT THE D-BOX AND LEACHING WERE NOT.EXCAVATED. THERE WERE NO WATER METER READINGS AS REQUIRED. QUESTIONS VALIDITY OF INSPECTION BY JOHN GRACI. Actions Taken/Results: DS AND SW WENT TO SAID PROPERTY AND TOOK PHOTOS ON FILE SHOWING NO EXCAVATION AT D-BOX AREA OR LEACH PIT. THE SYSTEM WAS LATER VARIFIED AS A FAILURE BY MR. HARVEY. THE SYSTEM WILL BE UPGRADED AS REQUIRED. THE INSPECTION REPORT WILL STILL BE ADDED TO THE PROBLEMS BY JOHN GRACI, AS THERE WERE NO WATER METER READINGS, THE DIAGRAM DID NOT SHOW BUILDING SEWER OR WATER SUPPLY LINE AS REQUIRED. ACCORDING TO MR. HARVEY, THE D-BOX AND THE LEACHPIT WERE NOT IN THE SAME LOCATION AS MR. GRACIS REPORT. Investigation Date: 1/31/2003 Investigation Time: 11:00:00 AM 1 Town of Barnstable ti Regulatory Services BARNv MASS. Thomas F. Geiler, Director 039. i. 1% Public Health Division Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 February 13, 2003 Mr. Francis McDonald 27 Fortes Way Osterville, MA 02655 RE: Septic System for 59 Rosemary Lane, Centerville Mr. McDonald, Per your request, I am writing this letter to confirm the capacity of your septic system for the three (3) bedroom dwelling located at 59 Rosemary Lane, Centerville, MA 02632. Currently, the septic system includes a 1,000 gallon septic tank, a distribution box, and a soil absorption system consisting of three (3) five-hundred (500) gallon leaching chambers with four (4) feet of stone on all sides. The fact that there is a garbage grinder in the dwelling, raises questions as to whether the system is sufficient enough to include said garbage grinder. Under Title V of the Massachusetts Department of Environmental Protection, the following is required when a garbage grinder is present: "Area requirements (for the soil absorption system) will be increased by 50%..." Additionally, Title V reads, "...A minimum tank size of 1,500 gallons and a two compartment tank or two tanks in series..." This system is capable of sustaining four hundred fifty-four (454) gallons per day. To include a garbage disposal, the soil absorption system would need to sustain four hundred ninety-five (495) gallons per day by the following calculation: Leaching capacity of 446 square feet 446 x 50% = 669 square feet The existing square footage of the soil absorption system is 614 square feet, thus resulting in an insufficient amount of square footage to sustain a three bedroom house and a garbage grinder. sl Therefore, two options exist. First, the system can be upgraded by hiring a licensed engineer or Registered Sanitarian to design a septic system to include the garbage grinder. The second option is to completely remove the garbage grinder. If you have any questions regarding the information provided to you, please don't hesitate to call the Barnstable Public Health Division at 508-862-4644. Sincerely, Samuel H. White Health Inspector YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate7ou must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Towr, Clerk's Office, 1 st. FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. Y DATE: �-�y_j�/. Fill in please: EA s APPLICANT'S YOUR NAME/S: (a)� BUSINESS YOUR HOME ADDRESS:_ rf /2-0sc kyt✓-Y Lam!V1 atg TELEPHONE # Home Telephone Number 7 7 9-83 C-600 V' 4 NAME OF CORPORATION77 11M4ME OF NEW BUSINESSTYPE OF BUSINESS o T�l�►NG-fi ��� IS THIS A HOME OCCUPATION? . YES . NO [ � vo ADDRESS OF BUSINESS `.S�l. r?o hAfftY `-ti ENS c��e vice- t o2 3x."MAP/PARCEL NUMBER (AsseSsmgJ When starting,a new business there are several things you must do'in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO T0.200_Main St. - (corner of Yarmouth Rd. & Main Street] to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has bee for��ld of the permit requirements that pertain to this type of business. 6NUj kd9f1J38 SjVjNg1b'W lie h IM A, idw0-isnw Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS[LIC NSING UTHORITY] This individual has be infor e o e lice.nsing requirements that pertain to this type of business. t" .t i COMMENTS: e� r�tuC1/��0/lit-� ��JJ'��((TT���� ajc ss 9 5- L^ 2 5-5 f r _V w Date: .3/ / TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: _k;r-Y4n/S 'q mh1tr-_ � BUSINESS LOCATION: 59 ✓�� �� LN, c�.vllr LL_G d ®z�3� INVENTORY MAILING ADDRESS: ->•,G TOTAL AMOUNT: TELEPHONE NUMBER: 774-?,3c,-(Gocy CONTACT PERSON: r& EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: I&DkT C_LC= KJkQ& -r G- cTrZc��cS ►.� ;i,�t�,��c,y INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: Nome Last shipment of hazardous waste: Name of Hauler: Destination: Waste Product: Licensed? Yes No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous material use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The board of health and the Public Health Division have determined that the following prod ucts.exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed / Maximum Observed / Maximum Antifreeze (for gasoline or coolant systems) Miscellaneous Corrosive ❑ NEW ❑ USED Cesspool cleaners Automatic transmission fluid Disinfectants Engine and radiator flushes Road salts (Halite) Hydraulic fluid (including brake fluid) Refrigerants Motor Oils Pesticides ❑ NEW ❑ USED (insecticides, herbicides, rodenticides) Gasoline, Jet fuel,Aviation gas Photochemicals (Fixers) Diesel Fuel, kerosene, #2 heating oil ❑ NEW ❑ USED Miscellaneous petroleum products: grease, Photochemicals (Developer) lubricants, gear oil ❑ NEW ❑ USED Degreasers for engines and metal Printing ink Degreasers for driveways&garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Miscellaneous Combustible o� 16,E -Car wash detergents �;_TuT�� Leather dyes A- 2G� 1 � 4L-C�waxes and polishes c;3� r -iv Fertilizers Asphalt& roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (including carbon tetrachloride) ❑ NEW ❑ USED Any other products with "poison"labels ` (including chloroform, formaldehyde, Paint&varnish removers, deglossers hydrochloric acid, other acids) Miscellaneous. Flammables Other products not listed which you feel Floor&furniture strippers may be toxic or hazardous (please list): y� Metal polishes t'J yak<c Laundry soil &stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) Other cleaning solvents Bug and tar removers Windshield wash WHITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS Appli s Signature Staff's Initi s Message Page 1 of 1 Lavelle, Timothy From: Lavelle, Timothy Sent: Monday, March 31, 2014 9:41 AM To: 'Bryan Braley' Subject: RE: MSDS Bryan's Mobile Marine OK. Thanks, Bryan. Please note that each of these products is in fact considered slightly toxic. However, because of the quantities that you plan to keep on hand, no hazardous materials permit is required at this time. Also please see the attached vehicle washing policy for businesses and note that any waste rinsewater from vehicle washing is considered industrial wastewater and must be collected and disposed of properly. If you do any.work at marinas, they would require this anyway due to strict EPA regulations. Let me know if you have any questions. Timothy J. Lavelle Hazardous Materials Specialist Town of Barnstable Public Health Division 200 Main Street, Hyannis, MA 02601 508-862-4645 tim.lavelle@town.barn stable.ma.us -----Original Message----- From: Bryan Braley [mailto:bryanbraley@ymail.com] Sent: Tuesday, March 25, 2014 12:03 PM To: Lavelle,Timothy Subject: MSDS Bryan's Mobile Marine Tim, here are the MSDS sheets for chemicals to be used for now. Note; the only product that is washed off with water is the Gel Coat Wash & Wax. All other products are applied and wiped off with a rag. Please let me know if need anything else. Regards, Bryan Braley 774-836-6004. 4/2/2014 APPLICA`T70N':F0R .Pr.RCOLATION TEST AND OBSERVATION `PITS` ` ')CATION NO. ILLAGE DATE PPLICANT - -.._ o----- -- ---..._--------------------- rrr -_-�c� -] )DRESS TELEPHONE NO. (Non-refundabl.6) 11GINEER ��- TELEPHONE NO 1TE SCHEDULED (Applicant' s signature) - . . . . . 00000,o . o . 00. . a . ., 00 . . . . . . ..000 . . .:; . . o.... . . . . .. . . . . . . . .'. . . .:� . . o . ,, . .:. o.� . � ... .:. . SOIL LOG IJB=DIVISION NAME DATE, ��F� rZ 1�1. 5 TIME��oa- 15'�a l _ � L �' N'�PANSION AREA: YES (/ NO � GINEER ' ')WN WATER (/. PRIVATE WELL (' � � �5�.� BOARD OF HEALTH EXCAVATOR 1-,ETCH: (Street name, etc. ,dimensions of lot, exact locat on of test holes and percolation tests, locate. w.etlands in' proximity to test holes ) . NOTES.:. I IS - . d . ':RCOLATION RATE: e (^ :S.T HOLE NO: ELEVATION TEST HOLE NO: ELEVATION: ,. - 2 2 - 3 3 _ 4 4 ------ 6 6 fug,t� 7. 8 8 9 9 10 _ 10 11 /3Z 11 1 2 , Q4, 12 • r 13 C'iE+p h 13 14 14 15 16 . 16 'JITABLE FOR SUB-SURFACE SEWAGE.: LEACHING FIELD EACH G PITS LEACHING TRENCHES }SUITABLE FOR SUB-SURFACE SEWAGE.: REASONS: : ►TE: ENGINEERING PLANS MUST SHOW NUMBER .ASSIGNED ON .PERC TEST APPLICATION ".1GINAL: ,, COMPLETED IN ENTIRETY BY P. 'E . AND RETURNED TO BOARD OF HEALTH env• RF.TATNED BY APPI,TCANT, No... :L ... ..-1. I Ficz......................... <e Ct THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ,..7..T04.,J ...............0 F771?J�k,15TA-1 ................................. Aplifiration for Bispasal Works Tonstrurtion thrutit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal System at: ...........4.. . ...................U_ ......................................................... ... ......... o,.-..Address fsl ........ ............................................. CA 0A.Z. ... . - L n Ad ss ........ ............................................ ........................................ Installer Address Type of Bui ng' Size Lot -I.fffD.......Sq. feet Dwelling—No. of Bedrooms-------%3--------------------------------Expansion Attic Garbage Grinder 04 Other—Type of Building ........................... No. of persons....---......_.............. Showers Cafeteria 04 Other fixtures .................................. ........................................................................................... Design Flow.........Jjo cWry .............................gallons. �Q.gallons .....gallons per ii re Total.daily flow.. Septic Tank—Liquid....c'a"p"`a'c*i*t y Length Width;. Diaw&ter .............. Depth... Disposal Trench—No..................... r id .....i.. ......... Toh lSeepage Pit No_,0.14e� Diamete ....../P....... Depth below inlet.....6........... Total leaching area.?C*12.sq. ft. Z Other Distribution box Dosing tank ( ) 'j- 0-4 �jpg- Percolation Test Results Performed by...._. . j__-*,-*..................... Date.....11.-:�:!J J ....... .................... Test Pit No. 1...... ...minutes per inch Depth of Test Pit.../AS........ Depth to ground water..� Test Pit No. 2..... ..ijillitites per inch Depth of Test Pit.... Depth to ground water. 0 Description of Soil.................. ......... ...................................... ............................... .......... ..............................................j ..............xv.%�Q a ...... lite U _Q jw— cl h ................ .. . ..... ........... ............................. U Nature of Repairs or Alterations Answer when applicable...................................................................................I............ ....................................................................................................................................................................m.................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of.I':Li: 5 of the State Sanitary Co The ersigned furjthW agrees of to plac the system in Ig I operation until a Certificate of Compliance has bee Sanitary ied e bp4rd oyll wn,11. 9 Signed. .. ........ . .. .......... 2,1 F. " ..... ... .......................... (,_�ate Application Approved By............................ .................. .......VV-tl—\ .................................... ..................... ..7.......... - Date Application Disapproved for the following re S:............................................................................................................ ....................................................................................................................................................................................................... Vee Date PermitNo.........VJ......&.. ................... Issued....................Date............................... dzi No... .......L..........L 1 F>ns....... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -•--..........©... +...................OF`"` - ti��,; .......................... Appliration for Disposal Works Tonstrurtinn Permit Application is hereby made for a Permit to Construct (/) or Repair ( ) an Individual Sewage Disposal System at: l /� 1 Location•Address r� t `or Lot No........................................... W ��Al<t N W .Ad`diess •...... ................ a ..... t N-c i - - . j w Installer Ada ess' Type of Building Size Lot... / .0.. .......Sq. feet aDwelling—No. of Bedrooms......:�a...............................Expansion Attic ( ) Garbage Grinder ( ) p, Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) a' Other fixtures t Design Flow.........41.��..........................gallons per person per day. Total dailY flow..'�2.?0 ..... gal Ions. Septic Tank—Liquid capacity 12 ?.gallons Length..--..ZLI. Width__.�!.`L._ Diameter:".......... Depth.-<'-7..... W Disposal Trench—No..................... Width............._..... Total Len Total leaching x _ gth......-----i---•--•- area_..�.r.�..C�...sq. ft. 3 Seepage Pit No..!:�.1�%..__.... Diameter......,!©....... Depth below inlet..... .......... Total leaching area.--....:._.2.sq. ft. Z Other Distribution box G/ Dosing tank ( ) a Percolation Test Results Performed by.......�4-.J�::1�. U." .-.._:..!..L..................... Date.....1L.z n 01( a Test Pit No. I......1: minutes per inch Depth of Test Pit ��-.° .. Depth to ground water...I.1Q.hl F...... 44 Test Pit No. 2-----k k'...minutes per inch Depth, of Test Pit....Z-`-?-�."..__. Depth to ground water. c?r4 1'....... .0 Description of Soil...........................:....••----------•-•--...-•-� ••---....�...---.. , ....-----•---�----•---------------•---------s-----•------....-•-----....-- 2r\c..:m� �Y r. " _.. --•M AA'' ..... �1 ;... 11 .1"- _.1GP�" , _ �_(_�c��,:? y,�f(l1,.X. `'..Sc.!�r! �t / :._.. . ....�yl n�.--r,.`.Gl .....�......V`"�. �1,�Y�C1 ......................................................... U Nature of Repairs or Alterations—Answer when applicable............................................................................................... •---•--•--------------------------•----.........-•-•-•--..........................................--•---------....-•----•..---•-------••••---•-----_.....•--•--........----............................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of A ITL: 5 of the State Sanitary Code= The,un ersigned further agrees not to place the system in operation until a Certificate of Compliance has been�s ed by tht and of health. Signed. `!% `. _ .........................O r Date - Application Approved By............� �/� 1 .....1.-... _ �:::�........ Date Application Disapproved for the following reasons:............••--•---••-•-----•----••-•--••-•-----..................---•••-•--••..•-- .............. ------•--•..................•--------.................----........---•-••---------•-----..................•-•---...---...............-------••--•--•--••--•-•-•----------.....----....................... ` ����� Date PermitNo......... ..................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH . .?...-........!.....I.......OF. y. .....S Tntif uttte of Tompitattrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed 0c)•or Repaired ( ) by................ t ...� ��s ..... 1; -r .......... ......... ......... ...................._........ .._._ ..... .. 1 Installer at........... .............................................................K ...n..- .. ( �.. co', -•................... _.-*....... .......... _---•----• rr t ... .........-. has been installed in accordance with the provisions of TITLE 5 of The State Sanitary Code as described in the application for Disposal Works Construction�Permit No..._. �-_::..` :.�... dated........ ................................. THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS.A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........'/'/ f.................•---.....--• ......... Inspector � .:.` "_..................................................- .—r��...+w..r..a.o—...,.�w.. •.n.n..w-.n.:+...w e,w r..e.:.w vw. ra.. ..a . ... .. .. n. n .,r w .Ta..n w .-.. ✓ -,•.n..u+a...w....,...........r. yw. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH G� -- ' ...............OF.. ..:,. , No...5.�. ..+'1 [ ......... ..................••----•----- FEE............_ ..... Disposal Works Tunstrnrtiun Permit � � � ,� Permission is hereby granted................. ti� C ` � �1'°.-. ,r ��.....i.................•.........................................�. ..... to Constructf( ) �r Repair,( ) an Individual.,Sewage Disposal System at No........... ,. -. ?_...... /C_ r -�:. .....v Street I as shown on the application for Disposal Works Construction Permit No..- !..`.4�Dated........I....... . .-. 7 ............................................................." 7 l ...f�✓�E- l C! �1 r Board of Health DATE................ ---•--•-•-•--.....--••----...--•---•--•---•--•.............. (�� • TOWN OF BARNSTABLEL LC ```kTION ®Se SEWAGE # VILLAGE (f-i24 � (/IZ ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO.uT4,4j �- q,2) Z 6 Vr SEPTIC TANK CAPACITY /DOa M4 LEACHING FACILITY:(type) �i^c C/1 5� 6 (size) ®OO i 00 NO. OF BEDROOMS PRIVATE WELL OR PUBLIC WATER BUILDER OR OWNER �V � ITV f/ { DATE PERMIT ISSUED: DATE COZIPLIANCE ISSUED: VARIANCE GRANTED: Yes No 1 b, ® e �I zp z3 �'j - - r _. . SECTION S AGE 1 �}o'TE;..--gEI�CW. MAPIl SEC = - - -- -- ,- _ - -- - . _,t} ;.. .'TaR OF_C.B. to S•�. Cot2NER. __._ _ _. SoUT H OF 1NTEiz. OF- )?-dSEMPIF�Y NY1- 120A1) 1 -SEPTIC TANK = 5 _"D"BOX...- ` - LEACH p1T,. 1t TOP OF.FDN p 47'1��I?(MSL). 112"OF I'sTO 11211 WASHED STONE Igo s fM A 2Y 2 .A.NV�. 1l,, '�. 4�.8�-.r _F �t2•_-- �.- �3 - )oo oo' IN- OUT I tt OUT• �raLfri, t Id)I {I.1I11 / 1000 INS OUT- SEPTIC IN. q� �Smt' r( ?�I _- 43.50 43.-aTANK ELEV. ELEV. ELEV. ELEV. ' 6 0'; i _Zs( di / gZ90 42.'?3 3Co.5 6� 3 N ELEV. ELEV. ELEV• •1 2� 1 G `\ � L_Q T — �� WASHED STONE /� L C�T . 0 p ' TEST HOLE LOG fi r.P go3S J,cotll,olJ , z-12-8< f o i p o _ TEST BY "R-7FAI"I$`k 4K,PE. � � �'1,271 WITNESS I TEST DATE J BEDROOM HOUSE I DESIGN +1 T.H. # 1 T.H. # 2 _.� ELEV. ELEV. q�,S NO RI r �}I J 3( �: LOAM DISPOSER DISPOSER susso� 2q" 44.5- AM t PERC RATE L2 MIN/IN. 1 42.5 3(9": gd I. �2,5 GAL./DAY) 3 30 I �o FLOW RATE 33O t ILEA L,EA SEPTIC TANK 3 A (1.5)= 95 I 4 I mep Ef71 M REQ'D SEPTIC TANK SIZE I000 SAND AtJV LEACH FACILITY SIDE WALL 10 �'0 =:1Sb-5 sr�(2.5) �I`7 r.2 G/D. _ 13Z BOTTOM l0'�/9 = '78•rJ ( 1 .0) = 178.5 G/D. ( q4 6 33.5TOTAL, og�,7 G D. sI L-r Iq BCD'?. Si.S•-f•. LEAN $AND /S(p'' 3z b f C3o.S, USE: a►.3>= —LEACHING "IT ICOB '`'O WATER ENCOUNTERED 1OI er'. Ct1Q.. X. F u t _ NOTES (UNLESS OTHERWISE NOTED) 1. DATUM(MSL)+TAKEN FROM.__LLY_AhN_� ________•-______QUADRANGLE MAPX°/ t�OF 2.MUNICIPAL WATER___________�_ ______---------------AVAILABLE << ARN •��,�� _ 3.PIPE PITCH:40"PER FOOT 4.DESIGN LOADING FOR ALL PRE-CAST UNITS:AASHO 1 1O --44 A G E H. 5.MIN.GROUND COVER OVER ALL SEWAGE FACILITIES: (1) FT. O JALA E 6.PIPE JOINTS SHALL BE MADE WATER TIGHT 4 CIVIL c i 7.CONSTRUCTION DETAILS TO BE ACCORDANCE WITH COMM.OF MASS. No. 30792 _ STATE ENVIRONMENTAL CODE TITLE 5 SITE PLAN STE '� -4 /t� Kassa Locus: RE AL ENGINEER H. OJALA <^� REF: -^ ;rJ WOW ca a en ineerin 4 # 3�13 PREPARED F R ..V1 L°A.N 3 a<I n A R O — 1 4t CIVIL ENGINEERS ! LAND SURVEYORS — --- 15 BOARD OF HEALTH REG.L EYOR _ _ L 826 Main'83. CONTOURS (EXISTING)------ --- - - --APPROVED- - .- —DATE MA MA h YawrN1�..0/A SCALE 3 DATE 3 —I6Z (PROPOSED)—0-0-8--O_ ; d��s E5�/L. S� T sY W E GE f S .�I sT' M PR E 4G.2 N I S Y , P � j �o,9�'J LMA r G X Inl. 4 M _ N G A .M X 0 G M/1'X 9 M N Y• 7 3 / G tJ DX N/ S YR 137 B M,° 7 5 / I!V .SG �. 3G MAX• V � �¢ l2 STONE W s N V 42 2 Co E� O , c . 2 9 E 4.4. So N c 40 4 P V 5'c Le v�L , 9f H �D PVc n2 - 0S cN 4o PVC IAA //J V. )NV. o N. /¢ : ilk1V1� v / /DYR / G 3 - 3 G' ¢' D 43.8 /4 //s /�- 1/i � 43,44 .1 43 9 :95Z•7 q-24 B WAS t� � 1 � � 0 W ASHEv � s rlr=n GA Es E sTo EFF. ENTH L ., ToN 3 G CFl 6 5 D 2 D 6 cG. `43. 8 BAD OF ,� 500 AL /}M 9 � o ..o e o •S QA oo 0 0 • . s 9 o aDA e , C2dSti�� e o o a s6 b 9 Oe ,�♦r, ,� o o b eose A USA /ST/n/6 !DDO G.3EPTtG T /JK , Lo s E O . O !2 3 - 8 . o' 2- E t/ / YR / s c M ! M /L A.BSORPTI dN SY T M SO 5 2 5 2: y SAND o TTOM 7�ST P T • B OF L E , 3S Z 33.S 3 2 ._ [/ _ 'Gh'oClNDlt/,�17�,P NOT "�/t/CO �yTC/ZED • - r G _ .9 s 50/L,5 TAT` r� 3 0 3 L O L SO/ S 'Ef/AG�l�9 T0.2 �/OHN .h Y E 4 o 3 d G EAR c : O 5 L H H! M23 E,2 5 X A-1 ,4 14 EkC�V/�TO.e .d A V� I3G! �/ G E 4' C C, ATE WASNEd STONE P R ' 4 . PEy?c, D E/'T D lc/ D pc.AlV VIEW � S A.S. SGAL 1 1 _ G �SSESSDrt' /V1A,o /47 P 2C�G 7 /Od.oo �L �- SELVAGE. SYST M, .l� S/G N _CAL cc,IG TONS � 9 La T /l/0. 1 R-1 / 3 1��.Ur�'04MS�}'//G GP1>�/3�,E�lvl. - 230 G Ph L N1 A �� ` Kos 2 . ��q v/2�D ABSD�YPT/ON ,9,eF.9 . D 330 GP1� O. 7 G F .DA �}¢G S•F 3 oos -� Fx/s ING 3, sE TI/R�E 3 .SOO G. LE�lGH cH�9Ma��s WiT� 74 � b L G .1>{-VGA G /N of 1�as �sTb�E A1E'w1Vh . /N�/LT/�A /G�V ��9 qs� � T .9� X E 45 0 90770 M .9,C�A - /2. 83 X 3 3. S 42 9 5: O UTE Q � S/1�� �9.PE�9 8 ?-O TAG E G S. \ .9Q A / TJ 31 to 0 o G. , O TE EXI T/N� G 54 G/--//NG 5 �9/ .0 /�/PDPOSED 4 8 � S s M P A E L/-1/�•./ N �'El�/AG � 3 , // N of P P ti 1o� o � s P. .f•4 N 0► '0 DOYLE,111 rn *�� ,sJ' No. S E iP EG L /n/G WtIUAM G EXI T/NG 3 � _UEBERtrlAfi o D SURE 0a �71 �a ti � L/A G 20 0 �" 8iC' /�y 3 co� s /GAS.E n/ FEE T 0 30 �D YGE .9SSDC14TES 7EG; ter-Og . :5-G-3 /994 P 0,_BOX 59S W. 5,11-A 54/7W., MA . 02.5'74