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1199 SHOOTFLYING HILL RD - Health (2)
1199 Shootflying Hill Rd Centerville F/R A = 190 192 Slll � 21 llll � UPC 12534 0.2-163LOR 1tA�TUiYi�YN fl/Commonwealth of Massachusetts r / q0 - 07 . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owners Name information is I required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection f.7l Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information ``�Ngttlltrlbly��� on the computer, "/� / ���`` pA OF S 15% use only the tab 1. Inspector: v I # D�I ��_� '••. ••• s'9C'�'� key to move your p:• '•,SG cursor-do not James D.Sears = JAMES use the return Name of Inspector key. CapewideEnterprises,LLC •,o o Company Name ��•s •�R rTF 153 Commercial Street 4i r5 INsuEG�.�``�� Company Address ,ate, Mashpee MA 02649 Cityrrown State Zip Code 508477-8877 S 1623 Telephone Number license Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ct4z5���o 5-29-15 spector'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. ojY4VS t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foam-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information is required for every Centerville MA 02632 5-29-15 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: The system is a 1000 Gal. Tank D Box and three cambers. 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", "non "not not determined" (Y, N, ND)for the following statements. If".not determined," please explain. The septic tank is metal and over 20 years o1d*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): t5ins•W13 Title 5 Official Insp ection Form:Subsurface Sewage Disposal System•Page 2 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 'y 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)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): 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-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has 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 ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in wappW is less than 6" below invert or available volume is less than %day flow -/- FBI 111N C t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner owner's Name information is required for every Centerville MA 02632 5-29-15 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water qualityan analy sis. [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 ppnr, 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 faffs. 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 II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3/13 Title 5 Official Inspection Farm: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 1199 Shootfl in Hill Road Y 9 Property Address Rick&Suzanne Thompson Owner Owners Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 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 th❑ � e facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)) D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Forth: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 y� 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owners Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D Box and three chambers. Number of current residents: 3 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): 2013-53,000Gals 2014-44,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present 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: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 i Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. Cityrrown 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: 5-7-13 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3113 Title 5 Official Inspection Forth: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 y` 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 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: 2003-Permit#2003-343 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 20"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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 911 Depth below grade: 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. Precast H-10 Sludge depth: 3" t5ins-3/13 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 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 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 27" Scum thickness 2" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Asbuilt-Tape Sludge Judge 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 at working level. Tank and covers at 9" below grade. Inlet baffle, outlet tee. No sign of leakage or over loading. Note:Tank inlet cover, part of cover under deck step, can be opened. Tank should be pumped from inlet cover. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection 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 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 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.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D Box is 16"x16"-26" below grade. Box is solid w/one line out. Box has some solid carry over. No sign of over loading. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 3 ❑ 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.): Leaching is three chambers30'x10' . Ck D Sox-Camera out to chambers and hand dug test hole at chambers. No sign of over loading or wet sand above or beside chambers. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 I Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 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 i r It V EAR 43 I -oB C_ `C_ t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts ugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells No Estimated depth to high ground water: 11'+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: 5-15-03Date El Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: Checked with local excavators installers ❑ sta ers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: T.H.on Design plan 5-15-03 no G.W. at 11'+. Bottom of leaching at 5' below grade. Bottom of leaching at 6'above T.H.Depth. Before filing this Inspection Report,please see Report Completeness Checklist on next page. l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 Shootflying Hill Road Property Address Rick&Suzanne Thompson Owner Owner's Name information required for every Centerville MA 02632 5-29-15 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 drawn on page 15 or attached in separate file t5ins-3f13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 Commonwealth of Massachusetts Title 5 Of p Official Inspection Form - - � Subsurface Sewage Disposal System Form Not for Voluntary Assessments - j 1199 SHOOTFLYING HILL RD Property Address Address C/O D_AVID HOLT TODAY REAL ESTATE 1533 FALMOUTH_ RD CENTERVILLE MA 02_6_32 Owner Owner's Name information is CENTERVILLE MA 02632 4/3/07 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. All 7 Important: A. General Information When filling out forms on the computer, use 1. Inspector: only the tab key to move your MICHAEL DEDECKO cursor-do not _ -- - use the return Name of Inspector _ key. COMPASS REALTY DEV CORP =. Company Name P.O. BOX 2384 Company Address MASHPEE MA 02649---' City/Town State Zip Code.. . 508-221-5003 Telephone Number License Number I B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: IgXpasses ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority ^AL 4/3/07 ----------- nspector'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. 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts r Title 5 Official Inspection Form — — � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD _—_.—___.___—_.__.—.. Property Address C/O DAVID HOLT_TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE_MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 --- ------ every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: y 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 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD _ Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTER_V_ ILLE MA 02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 ------ every page. CityfTown 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. 281 OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts -- Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w, a 1199 SHO_O_TFLYIN_G HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLEMA 02632 Owner Owner's Name information is _CENTERVILLE MA 02632 4/3/07 required for every page. CityFrown 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 ❑ IS/ 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 ❑ EQ ' Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/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. 281 OLD MEETINGHOUSE•06/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts _ _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is CENTERVILLE MA 02632 4/3/07 required for -..------— -- —-- — -------... — -- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont.): 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. ❑ [2 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. ❑ Eg/ 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 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. 281OLD MEETINGHOUSE-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERV_IL_LE MA 0_2632_ _ Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 --- —___ -- - — ------ ----- every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ [2"" Pumping information was provided by the owner, occupant, or Board of Health ❑ [V"" Were any of the system components pumped out in the previous two weeks? ❑ Lid 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? [v]'� ❑ Was the site inspected for signs of break out? [ ❑ Were all system components, excluding the SAS, located on site? [� ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 2810LD MEETINGHOUSE-08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632_ Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: r Number of bedrooms (design): 73 Number of bedrooms (actual): -- — DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): - . � Number of current residents: -- ---- Does residence have a garbage grinder? ❑ Yes ®r'No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes Eg-'No Laundry system inspected? ❑ Yes El`go Seasonal use? ❑ Yes ['g"'No Water meter readings, if available (last 2 years usage (gpd)): 4A-- Sump pump? ❑ Yes 0% Last date of occupancy: -- 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): ---- — ---- -- L281LD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 i Commonwealth of Massachusetts ---- .6 Title 5 Official Inspection Form - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments — 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632__ Owner Owner's Name information is CENTERVILLE MA 02632 4/3/07 required for --- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Or Source of information: Was system pumped as part of the inspection? ❑ Yes 2---No If yes, volume pumped: gallons How was quantity pumped determined? -- Reason for pumping: Type of System: f ❑ Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool Priv ❑ Y ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 281OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts _ Title 5 Official Inspection Form - 6 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD - Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner -- --- -- -- -----------._...-------------- Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): � 1 Depth below grade: -- ---------- feet Material of construction: ❑ cast iron E'40 PVC ❑ other(explain): - —---- - Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): gg i V ' 1 '�-'i------ ..t. � ram- �, � �C:G ._•<r e C> c 7 Septic Tank (locate on site plan): Depth below grade: 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: -- Sludge depth: ----- Distance from top of sludge to bottom of outlet tee or baffle -- --- --- rt Scum thickness - -- ----- is Distance from top of scum to top of outlet tee or baffle ----- ---------------- i - � Distance from bottom of scum to bottom of outlet tee or baffle --------------- How were dimensions determined? -� U U C - ------ 281 OLD MEETINGHOUSE-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 15 Commonwealth of Massachusetts _--- W� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner Owner's Name information is required for C_ENTERVILLE MA 02632 4/3/07 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.): c w 1 U J�_� 0�a.' Pic.. ���.� � C' 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): Depth below grade: -------- ------ Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): 281 OLD MEETINGHOUSE-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 15 Commonwealth of Massachusetts, -----� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 _ Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 ---- - - — -- ---...._------_...--------- 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) (locate on site plan): Depth of liquid level above outlet invert e y� �� L��. --- — Comments (note if box is level.and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): --------------------- Pump Chamber (locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No L2811 OLD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOL_T TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA_ 0_2632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 _ _--- _ every page. CityrFown 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: ----- - --------- ❑ 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.): r wl 1 I V r 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form.Subsurface Sewage Disposal System•Page 12 of 15 i Commonwealth of Massachusetts _ _ = Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD ------- - —-- ---- ---.._._.._.. —--- Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA 02632 Owner - ---- ---------._.. Owner's Name information is required for CEN_TERVILLE MA 02632 4/3/07 __ _—. — --- -- every page. City/Town 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.): 281 OLD MEETINGHOUSE•08106 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 r - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALMOUTH RD CENTERVILLE MA_02632 Owner Owner's Name information is required for CENTERVILLE MA 02632 4/3/07 _.._ ------------- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 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. ,o r i 2810LD MEETINGHOUSE•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 f - Commonwealth of Massachusetts - - - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1199 SHOOTFLYING HILL RD _ Property Address C/O DAVID HOLT TODAY REAL ESTATE 1533 FALM_O_UTH RD CENTERVILLE_M_A_02.63_2 _ Owner Owner's Name information is CENTERVILLE MA 02632 4/3/07 required for -- ------------------------- every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: [Check Slope [Surface water ['Check cellar ❑ Shallow wells Estimated depth to ground water: t --- - ----- ---- -- 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: 281OLD MEETINGHOUSE-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 15 TOWN OF BARNSTABLE LOCATION �I 99 ��ov� :y y Pal, SEWAGE 00 3- 3y3 VILLAGE �'n 7�Pr//, � ASSESSOR'S MAP &LOT L ���a ✓ INSTALLER'S NAME&PHONE NO. LY SEPTIC TANK CAPACITY LEACHING FACILITY: (type) X (size) AI X 3 0 a NO.OF BEDROOMS 3 BUILDER O OWNE i�C A&0101�K PERMIT DATE: 3 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 1 kV 14 c�type 3 3(9 s l0"� 3o' s7onr ���� II p f fi � 13UX a7a ' 13 'Zob3-3 No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS ZippYtcation for Mi.5pogai bpztem Construction Permit Application for a Permit to Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. ���/ SryOof /% Owner's 4Y�e,Address and Tel.No. C�IMN It�� � C' ✓�lo„H, Assessor's Map/Parcel /✓y9 syD kj%y /V r` ifo/rya �7n e l/P 3 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. J.t. A�ho C',s�i�n°;v� Ste�.P., pe�� WAR/ F>ssae_ P.0.l3o+t 3�5 y.2 l.�.o t�rd.y„y L h. � f��'•d'rtl+ ./19A Oo��,�6 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 gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) L Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system 4 in accordance with the proAdBoar�o"Health. of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has bee Signe Date 7'v7 6 Application Approved by S Date 7 � Application Disapproved for the following reasons Permit No. PZUo?j'3 q3 Date Issued r7 -Z�—C ett)63- 3 3 S7 No., t ` Fee ' THE COMMONWEALTH OF MASSACHUSETTS Entered computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 01pprtcation for Mt.5poml *pttem Conotructton Permit Application for a Permieto Construct( . )Repair( )Upgrade( )Abandon( ) ❑Complete System ❑Individual Components-", Location Address or Lot No. ���/y S`iOo� /% r� Owner's Name,Address and Tel.No. Assessor's Map/Pazcel z& a20-2 Jnstaller's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. ' � .�'� Ay /7o Corr f�/v�7��pr► Sfe✓ph ,Qr�p An� e�SSD� P,R/3a( 3)5 -.4.,t, ? f./••»,J,'A A�IfI Oo��3G 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. gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) _ { Date last inspected: 3 f Agreement: The undersi Zned agrees to ensure the construction and maintenance of the afore described on-site,sewage disposal system in accordance v 1i the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been iss e ;Board of Health. Signed Date 7-a Application Approved by .S Date 7- 2-5^03 Application Disapproved for the following reasons ,,' Permit No. 2 W3- 3 y� Date Issued r7_ Z ,F THE COMMONWEALTH OF MASSACHUSETTS M- BARNSTABLE, MASSACHUSETTS _- Certificate of Compliance THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed ( ) Repaired ( ) Upgraded ( ) Abandoned( )by .T C Ay hto at �[� � �/,,.4 //, // ro, has been constructed in accordance .- with the provisions of Title 5 an&e for Disposal System Construction Permit No.2(�U 3—3L13 dated �` 2S-G Installer Designer The'issuance of this ermi shall not be construed as a guarantee that the system Wto� gnDate 3 S' Inspector - --------------------------------------------- No.2 0()3 3'f 3 Fee J THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi5po5al *p5tem Congtructton Permit Permission is hereby granted to Construct( )Re air( )Upgrade( )Abandon( ) System located at �/�1� ���� � and as described in the above Application for Disposal Systen Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Y Provided:Construction must be completed within three years of thedate of this permit Date:__�2 S U 3 Approved by 105 TOWN OF BARNSTABLE LOCATION _1 fl? 4eel SEWAGE #I 00 3 393 VILLAGE_ C��7�Pr(/, �lf ASSESSOR'S MAP&LOT 11 �?a INSTALLER'S NAME&PHONE NO. J Ag /fo SEPTIC TANK CAPACITY -X. /®OAS LEACHING FACILITY: (type) 3 cu (size) Al-/. 3 0 N R NO.OF BEDROOMS 3 BUILDER O OWNE ,Ke Ala PERMTTDATE: 7'a 5-r,93 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 V 10 3 e,1-tec 3 30 s i Q i L f -J n �� r IME Tp�� Town of Barnstable BARNS rA BLE, "9. Regulatory Services Department �p i6gq. �0 HIED MAC a, Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 12, 2007 Allan Rodrigues Dias 67 Albion Street Apt. 2 Everett, MA 02149 Dear Allan, The Town of Barnstable Public Health Division Office received a complaint regarding your property located at 1199 Shootflying Hill Road, Centerville. The complaint included allegations regarding the overcrowding of vehicles and occupants, as well as there being trash in the backyard. On February 8, 2007, Timothy O'Connell, Health Inspector for the Town of Barnstable knocked at the front door but no one answered. He observed many cars on property at time of visit. Please telephone me at (508) 862 4644 to schedule a date and time for an inspection of the interior of this dwelling. Sincerely, Thomas A. McKean Director of Public Health q:\boh complaint Itrs\1199 shootflying hill road.doc Certified Mail#7006 0810 0000 3524 8370 7P0161,e A1W YOU WISH TO OPEN A BUSINESS? tG� �� �� . ire 04 For Your Information: Business Certificates cost$30.00 for 4 years. A Business Certificate ONLY REGISTERS Y UR NAME i town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the To n Clerk's Office, 1st FL.,367 Main Street, Hyannis, MA 02601 (Town Hall). DATE: ®? • a 0•,0 � Fill in please: a APPLICANT'S YOUR NAME: AC; j I k0E c.� L M A y BUSINESS YOUR HOME ADDRESS: 1 tqq. S 1-IY i nq Ni ►� ;� ($&Fs 1 - 7s 3 ��erv�![9, r"l� Oa( 3 A TELEPHONE # Home Telephone Number: Cs �o2 `77$ -i15 J Ul 3 rr, N ME �1F NEilll 13f)SlNEfiS. i ..:.:.r.� f��i r�t. . �� . .......:. ... - ..:. _. . . ................... :r:. :_ ,. __., . ..r.:.......__.: J U ....,::.: ..........,......._...,. _.....:... - - - r , , rr! r, , , _ l r _ r - , r , t e b. l'l. �n .� �?...YE. 0...... r:... :�:!!:,... Ha ..o.+ been. . o.... W. ....... .......... .... q.. 4(...g_.._........... _....._..,...,,.r..,._........ ....... i;::�'�e When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -(corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OFFICE This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual been inf me of t e it requirements that pertain to this type of business. uthorized Vdnature** COMMENTS: jfNZ)A J_-,(A41'V1 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) e� This individual h een infQEmed of th i e equirements.that pertain to this type of business. Authorized Signature** COMMENTS: Date: 07/aQ l �,� TOWN OF BARNSTABLE TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: All C&bC, Glm n pO Sp-ry c S BUSINESS LOCATION: 112101. Sk=7'-'I�i nd Aj o w ° CeAkrV i ILe, INVENTORY MAILING ADDRESS: Q0Q.10YC 9 0A Cellk 'Vi lv MA ®a63a - qca TOTAL AMOUNT: TELEPHONE NUMBER: 509 '7-7 9 -7-75 3 CONTACT PERSON: !a Gk u2, Cb- a ma, EMERGENCY CONTACT TELEPHONE NUMBER: 117114 a)of 036 oZ MSDS ON SITE? TYPE OF BUSINESS: G lea n i nA INFORMATION/RECOMMENDATIONS: Fire District: Waste Transportation: 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 materials 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 products exhibit toxic or hazardous characteristics and must be registered regardless of volume. Observed/Maximum Observed/Maximum Antifreeze (for gasoline or coolant systems) Misc. Corrosive NEW USED Cesspool cleaners i 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 Misc. 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 Misc. Combustible Car wash detergents Leather dyes Car waxes and polishes Fertilizers Asphalt & roofing tar PCB's Paints, varnishes, stains, dyes Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor&furniture strippers Other pro ucts not listed which you feel a ✓ Metal polishes ay e t x c�or hazardous (please list): PYA V Laundry soil & stain removers (including bleach) Spot removers &cleaning fluids (dry cleaners) VA q ✓ Other cleaning solvents Bug and tar removers Windshield wash ITE COPY-HEALTH DEPARTMENT/CANARY COPY-BUSINESS COMMONWEALTH OF MASSACHUSETTS tag EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS > DEPARTMENT OF ENVIRONMENTAL. PROTECTION d R r M � TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSA S vI PART A CERTIFICATION J U N 14 2002 Property Address: 1199 Shoot Flying Hill Road Centerville TOWN OF BARNSTABLEC >� Owner's Name:Manning HEALTH DEPT. Ua J.'J Owner's Address: same 1 9 ®. ....E Date of Inspection: 6/7/02 MAP Name of Inspector. Timothy Lovell PARCEL Company Name:Accurate Inspections LOT Mailing Address:550 Willow Street p W.Yarmouth, Al FAILED INSPECTION Telephone Number: 508-771-3700-3700 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: Passes Conditionally Passes Needs Further Evaluation by the Local Approving Authority x ails Inspector's Signature: Date: 6MO2 The system inspector shall submit a"Pyofs inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall.submit the report to the appropriate regional.office of the DEP. The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform.in.the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 617/02 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: _N/A 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. _N/A 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 infiltration 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: N/A 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: N/A 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 I ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE IDISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 11"Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 C. Further Evaluation is Required by the Board of Health: _N/A Conditions exist which require fin they 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: _N/A_Cesspool or privy is within 50 feet of surface water N/A 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 an d determines that h y ( y) e state system is functioning in a manner that protects the public health,safety and environment: _n/a_ 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. _n/a The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _n/a_ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. n/a_ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Page 4 of I 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1199 Sboot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 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 _N/A _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 I 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: N/A 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 R 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. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 Check if the following have been done.You must indicate`des"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? _N/A _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 bales 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)] Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs. Manning Date of Inspection: 617/02 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):_3_Number of bedrooms(actual):_3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):_330 Number of current residents: 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):_n/a_ Seasonal use: (yes or no):_no_ Water meter readings,if available(last 2 years usage(gpd)): Sump pump(yes or no):_no_ Last date of occupancy:_Current COMMERCIALANDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): god Basis of design flow(seats/persons/sgk 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: Owner Was system pumped as part of the inspection(yes or no):_no_ If yes,volume pumped:_gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _x_Septic tank,distribution box,soil absorption system _Single cesspool Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank _Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information: Early 80's Were sewage odors detected when arriving at the site(yes or no):_no Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 BUILDING SEWER(locate on site plan) Depth below grade: 2' Materials of construction:_cast iron _x_40 PVC_other(explain): Distance from private water supply well or suction line: 50' Comments(on condition of joints,venting,evidence of leakage,etc.): No evidence of leakage venting is ok joint look tight SEPTIC TANK:—x_(locate on site plan) Depth below grade:_1', 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: 1000 gallons Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle: Scum thickness:_1" Distance from top of scum to top of outlet tee or baffle:_6" Distance from bottom of scum to bottom of outlet tee or baffle:_14" How were dimensions determined: Field measurements Comments(on pumping recommendations,inlet and outlet tee or bale condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): Tank looks to be in good condition no evidence of leakage tee's are in place liquid levels are at invert out GREASE TRAP: N/A_(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.): Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner:Mrs.Manning Date of Inspection: 6n102 TIGHT or HOLDING TANK:_n/a (tank must be pumped at timeof inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping:T Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_n/a (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:_nia (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.): Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner:Mrs.Manning Date of Inspection: 6n102 SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,excavation not required) If SAS not located explain why: Type _x_Leaching pits,number: 1 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.): 6' leaching pit water elevation was just 6"below invert in and only I person in home I failed system because if a family of 3 to 4 moved in the system would fail right a way signs of hydraulic failure no ponding vegetation normal CESSPOOLS:_n/a (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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY:_n/a (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Page 10 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 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. Back of Home Addition with no foundatio 63' 29' 28'8" 26' Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1199 Shoot Flying Hill Road Centerville Owner: Mrs.Manning Date of Inspection: 6/7/02 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_22'_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) _x Accessed USGS database-explain: USGS plate 2 You must describe how you established the high ground water elevation: Y g Information provided by Cape Cod Commission Well Data Well#AIW247 data indicates ground water elevation is 28.5 No.------ /............ JA............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OR HE LTH , ppliration -for Uitipviiat Work Tomitrurtion Prrmil Application is hereb made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System t: ---- -- --------- -- - --....... - --P •ion-Ad s No. Owner dress a ---•--••• .. ............ •• -- --• -•---• -----. ........................... --------------------- •--•- An Installer ' Address Q Type of Buildi( > Size Lot............................Sq. feet U Dwelling o. of Bedrooms------------ __________________Expansion Attic ( ) Garbage Grinder ( ) U aOther—Type of Building -_______________._________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) PA Other fixtures ....... ........ •------------------------------------------•---••-•-------•------------••---•----•---- W Design Flow.. ...................16-._-611,-_-_�_ allons per person per day.' Total daily flow----------Z_._..__.__.__.._._.-_...__..gallons. WSeptic Tank Liquid capacityp-%,gallons Length................ Width--------- ..... Diameter.-----.._.____-Depth................ x Disposal Trench—No-____________________ Width---------- _ _ a L h. .. .... ..... Total leaching area._..___._.___.-_____sq. ft. Seepage Pit No----- _ ' 1.___________ Diameter e w to tal leach' 1 __. sq. ft. .---- / l z Other Distribution box ( ) Dosing tank 7 � W Percolation Test Results Performed by........................................................... __.. Date--------.-..--__.-.--------_--------.-.. Test Pit No. I----------------minutes per inch Depth of Test Pit----------a........ Depth to ground water.._.__-_._.__.___-._-__. 44 Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water......--_______.____.._. P4 ----•---•----------------- ------- ----.- Description of Soil- � .< -�. x W UNature of Repairs or Alterations—Answer when applicable----------------_------------_------------------------------------------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------------------....--•---•---------------------------------------- Agreement: , The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signe �=fr Application Approved B / w Date Application Disapproved for the following reasons:................................................................................................................ ----•.............•••--....----••---.........._..-•-----------•--•---....-----------•------•----•---•-•-----••--•............---------•----------•-•---------------......_------------.....------•-•--•- Date PermitNo..................................•-•------------------- Issued....................................................... Date --------------------J No. F>zv.......1.D.............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HE LTH ....................... Applirtttilan -for• Uttip al War Tutuitrurtion Vrrm t Application is hereb made for a Permit to Construct or Repair an Individual wage Disposal osal(� ) P ( ) R system r _ -- . c t n-AdL 1\0 -- --: - ..: y ------ ----------- Owner dress p !�' Installer Address UType:of Buildi ' •►►' Size Lot....................._------Sq. feet Dwelling o::of Bedrooms............... ._.____________--__-_-__Expansion Attic ( ) Garbage Grinder ( ) aOther—Type:,bf,, Building ..............:............. No. of persons_-_-___--.-________.____.__ Showers ( ) — Cafeteria ( ) d Other fixture"§ ..----- __--•- ---------------••--- ------------ W Design Flow__ __fit____._.-__.: ,,�Mons per person per day. Total daily flow______ "__ __._._._._.::_._.._.__.__gallons. WSeptic=1 ank Y Aquid capacity/j�Ygallons Length________________ Width--------- .._.- Diameter_:.__.__---__-._ Depth---------- Disposal Trench—No_____________________ Width__ to L 1 __ Total leaching area........------------Sq. ft. Seepage"Pit No------/------------ Diameter._ e win T tal leachja � _.__... sq. It. Z Other Distribution box ( ) Dosing tank.( ) -- �-' . . (� I�jr'��... ► Percolation Test Results Performed bY----------- ------------------------------•--------------•-----••••--•---_.Date----------------------------------- Test Pit No. 1-----______.....minutes per inch Depth of Test Pit.................... Depth to ground water-.---_--____-._.--__--. G3:q Test Pit-No. 2---------_------minutes per'irich Depth of Test Pit--------------------- Depth to ground water--------------------- P-I' ..•_--- ..... ^s _ ------------------------------- D Description of Soil ................••:... _--�`•----.... i!"r!. 1'�'d- x - W V 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 Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by thq board of health.. Signe _A --_ - ------ ���/// . Application Approved BY-------=�'- . '-- ---- --- -- -- - -/�---'�''�- � - --R -------------- ,;-`�:"1't�---- ----��-- - -• Date Application Disapproved for the following reasons:-------------------------____________....................._-------------- _......... ._ _____.............. ........................--------------•--_..._....--------............................................ ------•------•-------•--...--•------••-•--•--------------•••-••--•••---•-.._._...--------•--- Date PermitNo......................................................... Issued,...................... ..............------------------ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD69Z A ` '..... ........OF...... ............ .................. rdifirtttae aaf Toutplittrtrae TH S TO CERTIF the Indi u$1 Sewage Disposal 'System constructed ( Repqired ( ) by.....A nstaller ; has been tn'stalled in accordance with the provisions of Article X, of The State Sanitary Code as scribe th application for,Disposal Works Construction Permit No...._.._. ft__:-_______________ dated_.:....: , THE ISSUANCE OF THIS. CERTIFICATE SHALL NOT BE.CONSTRUED AS A GU ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE..... Inspector .:./�--•---•••--------• . s ,. ...................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH • f ".:. :..OF ...................•----......... No.----- Aor .._..... •--•---•------- FEE---- �i_ aatt aark� Caariiqi#ar t ion rrutit Per4s* ' reby granted-•••--• -------. •••-•- ltt. --••- --••- -----• -•--- to ConsRepair ( n ndi a age pos S ste at No.._ ---_ . - -••-- - - ------- ---' ......... Stree as shown on the application for Disposal Works Construction Per D •...' ---••-- ... ••------- -- ard o Heal DATE.........-.......................................-'................-............ FORM 1255 HOBBS & WARREN. INC., PUBLISHERS w .. 'b } i Coy tic Ct>' 1��-t e...�{Z.q•3—��w c� 5v� ET Z G3' 48, q 4.5 E Oca� o -C tZAVt © W ^- � �APQQo�t. �svA-rEer t�nA�o� L..-©CA-t tow _ _ �_ NPTES Per �. 4 F PITNEY BOWES 02 IA $ 04.640 7006 0810 0000 3524 8370 0004606238 FEB 13 2007 ! MAILED FROM ZIP CODE 02601 '# r ADDRES9' l; _L'71"?( = .�' UNCL Q NO SUCH STREET?NUMSM Fk 1 QVACANT 'r _C7 NO MAIL.RECEPTACLE_rl DECEASED i _ V r L ` UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid 1 LISPS f ' Permit No.G-10 C Sender. Please print your name, address,-and ZIP+4 in this box • Town of Barnstable Health Division 200 Main Street r Hyannis,MA 02601 I I' a j I Certified Mail #70060810000035248370 P�°f IHE)Q�� Town of Barnstable • BA STABLE, 639 1 * Regulatory Services Department voo 639 PIED MAC A Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO February 12, 2007 Allan Rodrigues Dias 67 Albion Street Apt. 2 Everett, MA 02149 Dear Allan, The Town of Barnstable Public Health Division Office received a complaint regarding your property located at 1199 Shootflying Hill Road, Centerville. The complaint included allegations regarding the overcrowding of vehicles and occupants, as well as there being trash in the backyard. On February 8, 2007, Timothy O'Connell, Health Inspector for the Town of Barnstable knocked at the front door but no one answered. He observed many cars on property at time of visit. Please telephone me at (508) 862 4644 to schedule a date and time for an inspection of the interior of this dwelling. Sincerely, omas A. McKean Director of Public Health Chapter 170: RENTAL PROPERTIES [HISTORY: Adopted by the Town of Barnstable 6-1-2006 by Order No. 2006-125. Editor's Note:This order also provided it shall take effect 120 days after its final approval by the Council.It also repealed former Ch. 170, Rental Property,adopted 12-19-1991 (Art. LI of Ch. III of the General Ordinances as updated through 7-7-2003). Amendments noted where applicable.] GENERAL REFERENCES Noncriminal enforcement of violations— See Ch. 1,Art. I. Fees— See Ch.76. Noise— See Ch. 133. Solid waste— See Ch.202. § 170-1. Purpose. The purpose of this chapter is to protect the health, safety, and welfare of both the occupant(s)of rental housing units and the general public and to maintain the quality of life in residential neighborhoods. It will assist the Board of Health in the enforcement of state and local health and safety laws or regulations and provide a method of correcting violations when conditions require immediate attention, in particular, situations associated with recreational tenancy. § 170-2. Definitions. As used in this chapter, the following terms shall have the meanings indicated: BOARD OF HEALTH —The Board of Health of the Town of Barnstable. DWELLING—Any building or area in a building used or intended for use for human habitation, including, but not limited to, apartments, condominiums, cottages; guesthouses, one-,two- or multiple-unit residential buildings, and rooming houses, but not including any licensed facility. FRONT YARD—The area between the roadway and the part of the structure nearest to the roadway. LICENSED FACILITY—Any facility licensed under any state or local laws or regulations other than those registered under this chapter. OCCUPANT—Anyone residing overnight in a dwelling. OWNER—Any person who alone or severally with others has legal title to any dwelling, dwelling unit, rooming unit or parcel of land, vacant or otherwise; mortgagee in possession; or agent, trustee or other person appointed by the courts. PERSON—Any individual, partnership, corporation, firm, association, or group including a governmental unit other than the Town of Barnstable or any of its agencies. § 170-3. Responsibility of notification. No person shall allow occupancy of any dwelling without first notifying the occupant(s) at the time of such occupancy of this chapter and of Chapter 133, Noise, of the Code of the Town of Barnstable. § 170-4. Certificate of registration. A. No person shall rent or lease, or offer to rent or lease, any dwelling or any portion of a dwelling to be used for human habitation without first registering with the Board of Health, which shall determine the number of bedrooms and the number of persons such dwelling or portion of a dwelling may lawfully accommodate under the provisions of any state or local health and safety ordinance or regulation. B. The Board of Health shall, pursuant to-the above subsection, issue a certificateofregistration which shall be renewed on the following December 31, provided that the certificate may be renewed each year. = § 170-5. Posting of certificate of registration. No person shall rent or lease, or offer to rent or lease, any dwelling or any portion of a dwelling to be used for human habitation without first conspicuously posting within such dwelling or portion of a dwelling a certificate of registration provided by the Board of Health specifying the number of bedrooms and the number of persons such dwelling or portion of a dwelling may lawfully accommodate. § 170-6. Keeping of register. The owner(s) shall be responsible for keeping a register containing all names of current occupants in the dwelling. The register shall be retained for a period of two years and shall be made available to the Board of Health, the Director of Public Health, a health inspector, a police officer, or the Town's licensing agent upon request. § 170-7. Provision of names, addresses and telephone numbers of owners or agent. An owner of a dwelling which is rented for residential use shall provide the Board of Health with his/her current residential address and telephone number. If the owner is a corporation, the name, address,.dnd.telephone.number of the president and.legal-representative of the: ; corporation shall be provided. If the owner is a:realty trust or partnership,the name, address; and telephone number of the managing trustee or partner shall be provided. In the event•that'the owner does not reside within the Commonwealth of Massachusetts, the owner shall designate a resident agent to represent him within the commonwealth and shall provide the Board of Health with written notification of the name, address and telephone number of the resident agent so designated. § 170-8. Fee for registration. There shall be a fee of$90 to procure a certificate of registration. The-fee for any additional units owned by the same owner at the same address shall be$25 per unit. Editor's Note:Section 3 of Order No.2006-125 provided that,notwithstanding the provisions of this§170-8,the fee for the first year of registration, prior to 1-1-2007,shall be$40 and each additional unit owned by the same owner at the same address shall be$10 per unit. § 170-9. Parking restrictions. A. The occupant of a dwelling shall use, or allow to be used, no more than 25% of the front yard and no more than 20 feet of frontage as a parking area and/or driveway. B. Nothing in this section shall be deemed to'supersede the parking requirements set forth-by, site plan review. § 170-10. Smoke detectors and carbon monoxide alarms Eve owner shall test and perform maintenance on ever smoke detector and carbon monoxide Every P Y alarm upon renewal of any lease term for any dwelling unit or on an annual basis, whichever is more frequent. Any detector or alarm found to be defective shall be repaired or replaced forthwith. The occupant(s) must report faulty or inoperative smoke detector unit(s)to, first, the owner of the dwelling and, second, if necessary, the local Fire Department. § 170-11.Storage.and removal-..,.of rubbish, garbage, and other refuse. A. Owner's responsibilities. The owner of any dwelling shall be responsible for providing receptacles with tight-fitting lids to be utilized for the proper storage of rubbish, garbage, and other refuse. Said receptacles shall be located in such a manner that no objectionable odor enters any dwelling and so as to provide maximum screening from the street. The owner of any dwelling that contains three or more units, and the owner of any dwelling which contains one or two units which is rented or leased for a period of six months or less, shall be responsible for the final collection and disposal of rubbish, garbage, and other refuse at a permitted transfer station or disposal facility. B. Occupant's responsibilities. The occupant(s) of any dwelling shall be responsible for the proper storage of rubbish, garbage, and other refuse within receptacles with tight-fitting covers. Said occupant(s)shall also ensure that all tight-fitting covers are kept so that all rubbish, garbage, and other refuse which is stored outside the dwelling unit is properly covered. Said occupant shall be responsible for the proper use and cleaning of the receptacles and keeping the premises free of rubbish, garbage, and other refuse. Unless a written lease agreement specifies otherwise, the occupant(s)of any dwelling which contains one or two units and which is rented or leased for any period greater than six months shall be responsible for the collection and for the ultimate disposal of rubbish, garbage, and other refuse at a permitted transfer station or disposal facility. § 170-12. Inspections. Dwelling units covered by.this:section shall be subject to reasonable inspections by Town inspectional-staff. All interior inspections shall be done in the company of the owner, occupant or the representative of either.' § 170-13.Written notice of violation; time limits for correction. A. Written notice of any violations of this chapter shall be given by the Board of Health or its agent specifying the nature of the violation to the occupant and owner and the time within which compliance must be achieved. The requirements of this subsection shall be satisfied by mailing, through the United States Postal Service, or by delivering in hand as memorialized by an affidavit of any Town employee or officer authorized to serve any form of process notice to the owner or legal representative named on the registration. B. Violations of an unoccupied dwelling shall be corrected prior to occupancy. Violations found in an occupied dwelling shall be corrected within the time specified as determined by the Board of Health or the Director of Public Health. § 170-14.Violations and penalties. A. Any person who violates any provision.of.this chapter shall be subject to a fine not.to exceed. $300. Each day of continued violation may be deemed to be a separate offense.. . B. This chapter may be enforced under the provisions of MGL c. 40, §21 D. The fine for any violation under the provisions of MGL c. 40,.,§ 21 D shall be $100. Each,day of continued violation may be deemed to be a separate offense. § 170-15. Severability. Each provision of this chapter shall be construed as separate. If any part of this chapter shall be held invalid for any reason, the remainder shall continue in full force and effect. r Chapter 59: CONIPREHE SIVE OCCUPANCY [HISTORY:Adopted by the Town of Barnstable 6-1-2006 by Order No. 2006-126. Editors Note:This order also provided that its subject matter shall be examined by a committee appointed by the President of the Council before 10-1-2007,to report to the Council by 2-1-2008,with respect to any changes which may be,deemed necessary or advisable.Amendments noted where applicable.] GENERAL REFERENCES Noncriminal enforcement of violations— See Ch. 1,Art.I. Rental property— See Ch. 170. Zoning— See Ch.240. Subdivision regulations— See Ch.801. § 59-1. Purpose and intent. The purpose and intent of this chapter is to guide growth in accordance with the local comprehensive plan, so as to promote beneficial and convenient relationships between the natural resources of the Town and its inhabitants, to address,nutrient management and other environmental, health and safety issues resulting from overcrowding in residential dwellings. § 59-2. Definitions. As used in this chapter, the following terms shall have the meanings indicated: BEDROOM—A room providing privacy, intended primarily for sleeping and consisting of all of the following: (a)floor space of no less than 70 square feet; (b) a ceiling height of no less than seven feet; (c) an electrical service and ventilation; and (d)at least one window large enough to provide emergency egress. Living rooms, dining rooms, kitchens, halls, bathrooms, unfinished cellars and unheated storage areas over garages are not considered bedrooms. [Amended 10- 19-2006 by Order No. 2007-033] OCCUPANT—Any person who has attained the age of 22 who has resided in a residential dwelling for any length of time. RESIDENTIAL DWELLING—A single unit providing complete independent living facilities for one or more persons, including provisions for living, sleeping, eating, cooking and sanitation. § 59-3. Maximum number of occupants; maximum number of motor vehicles. A. The maximum number of occupants in a residential dwelling shall be determined by the number of bedrooms contained therein. A maximum number of two occupants is permitted for each of the first two bedrooms;for each additional bedroom a maximum number of one occupant is permitted. It shall be a violation of this chapter for any person in excess of that provided herein to occupy any residential dwelling. B. The maximum number of motor vehicles that are permitted to be parked overnight, other than in a building, at any residential dwelling shall be equal to two motor vehicles for the first bedroom in a residential dwelling and one motor vehicle per bedroom thereafter. § 59-4. Exemptions. Children under the age of 22 shall be exempt from these provisions. § 59-5. Enforcement; violations and penalties. A. This chapter may be enforced by the Building Commissioner, or his designee, the Board of Health and/or its designees or the police. B. The owner, lessee or person in a position of control of any dwelling unit found in violation of this chapter shall be subject to a fine not to exceed $300. Each day of continued violation may be deemed to be a separate offense. C. This chapter may be enforced under the provisions of MGL c. 40, § 21 D. The fine for any violation under the provisions of MGL c. 40, § 21 D shall be $100. Each day of continued violation may be deemed to be a separate offense. § 59-6. Severability; construal of provisions. A. Each provision of this chapter shall be construed as separate. If any part of this chapter shall be held invalid for any reason, the remainder shall continue in full force and effect. B. Nothing herein shall be construed as allowing for more bedrooms in any residential dwelling than are otherwise permitted by any state or local law or regulation governing health and safety. 4 21 Tv- Fin/Grade El. 64�t Fin. Grade El. 64 f • ale o'D1a �l ' 1b Remain � 118' to 1/2'' Washed Stone O 9' Moir .INV EL + ww e'— 60 5' 314' - 1 112' Wombed stone �t►-� �, `c' 11 INV ELp V ;: .- -,•-• ' I1YV EL 61.13 �:••.�:�::• :t i:: Stowe s,dth Yerlea to 4'Max •a ,„ ESJs 10 Yla 14 �.J • , P P ?b Bantam 62.13' 61.33' 2• a a a a' • 30 1/2" Height :as a a �� r M,,,n U o ,tie a •--• Lfquld level 48' :: . . :: : : •. a d o.' EYL Depth •d a �Q . 3 ----� s DLSTRIBUTION BOX ' a• 90 Length a u�� T Vie, .� C a a - °a EL 57 96 #hw o,. . ,�¢ GO @� with end caps �TR� �o CEVrEAVn.f.6 C► y< AD PRECAST REINFORCED CONCRETE DISTRIBUTION BOX 52" :►1 sn� �g"Il° Install on a level base a F Minimum wall thickness = 2" PROPOSED INFILTRATOR TRENCH 5 s""• ": a^=°�'- , ' ,��I3b � � ' �`++,Gan \ r +�• „ Minimum inside dimension = 12" Ll EXISTING 1000 GALLON SEPTIC TANK Outlet inverts shall be equal to each other and at 2" minimum below inlet invert. EI. 52.96 4 � hA The distribution lines from the distribution box shall all have equal inverts as determined by flooding the distribution box to Adj. High Ground the height of the distribution line invert after .all lines have Water <E! 50' (Mapped) L.O C ZT,S' -A/LA P been sealed in place. Invert adjustments shall be made by filling with durable and Tees shall be constructed of Schedule 40 PVC and shall extend ,a nondeformable material permanently fastened to the line or minimum of 6" above the flow line of the septic tank and be on reconstructing the lines until all inverts are of equal elevation. the centerline of the septic tank located directly under the clean-out manhole. The inlet pipe elevation shall be no less than 2" nor more than 3" above the invert elevation of the outlet pipe. Septic tank shall have a minimum cover of 9': Note: The outlet tee shall be equipped with gas baffle. Remove all unsuitable material 5' around SAS down to the "C" layer (El 60.0) and replace with clean granular sand per 310 CMR 15.255 (3), (4), (5). ,and (6). LOCUS ADDRESS. 1199 Shoot Fljdng Hill Road ASSA;P§S6RS MAP 190 PARCEL 192 � FEAfA DATA- ZONE. C" , GENERAL CONSTRUCTION NOTES 1. All the workmanship and materials shall conform to R E.P Title 5 �J and the Town of Barnstable rules and regulations for the subsurface ``�`•.163.64' disposal of sewage. 2• At least one access port over tank tees shall be accessible within 6" of finish grade, with any remaining access ports brought , `�� to within 12" of finish grade. .8 G � �• 3. All components of the sanitary system shall be capable of withstanding H-10 loading unless they are under or within 10 ft f ` '�.,64.00' of drives or parking: H-20 loading shall be used under or within _ . - 10 ft of drives or parking unless noted. Plastic equals may be -63 If I ,� \ used in lieu of all recast units Existing , 4. `The exca va tor1con tractor shall verif the location of all site 1000 Gallon ti Pa ved 'Y Tank To Remain �6 63. 7' Driveway o utilities prior to any excavation, and shall be responsible for g g, 62- o all matters relating to electric easements ti x °D , 5. Sewer pipes shall be 4" Schedule 40 PVC laid at 0.02 slope. Rim El + 64.18 GRAPHIC SCALE 6. Any masonry units used to bring covers to grade shall be ,�$�' 61.14 ; mortared in place ,'�I ' - 20 ° '° 20 40 a 7. Finish grade shall have a minimum slope of 0.02 ft per foot. 6 x9' 64.0' t47 x �'! % �' IN FEET Room Above � � on Sono Tubes ; % :�y i inch 20 M Pump & Fill * W. .y ; Soil Log or ,y� \w Remove Existing y ; Test Da te: May 15, 2003 Leach Pit and ��` 6 x 3 /EDWE'L I I 64.3' any Contaminated 5� � x �'o Soil Evaluator.- Stephen Doyle soils LOT 4 Se Wage System Upgrade Plan d/b 10,064fsq.ft ' ' ii:CS::r,:�i o �• ,�� JIz'q'+/_rCLSIP�r."Y• Prepared Far Pere Rate: <2 Min/Inch 64.6' Q ; poi 111. f�Y aON, THE MANNING RESIDENCE 30 >�o j� , Qp e ! ►1 EL 64 Design Data: 10� e d �•� 7V/7cJJ7cr! �. In s� 0„ Three Bedrooms = 9 X 110 gpd = 330 gpd Required Flow p � -`— •�1; " SL 10 3 2 (NO Garbage Disposal) 64.1 ti 64.3 hoo137 Cen t e1^Vllle, Massachusetts A yr 1 BM Top CB x sy� o 63.80 " ' / s _, ;., Scale: 1 = 20 Date: May 22, 2003 8 Use: Infiltrator Trenoh El. 64.37 Iory the '-S 3' „ „ 10 414 • > > • Da tum: NG VD.f• Prepared B B .Yl' / 48" [•30+30+10+10 J x 2 0 = 160 Proposed SAS 95r s 64.2 Stephen J. epaDoyle and Associates �. ss, 42 Canterbury Lane, E. Falmouth, MA 02536 30 r 10 = 300 +. t o *• MED 460 x 0. 74 340 GPD Total Design Flow �� t f Telephone: 5081540-2534 0 c TO l t9Eou, � e v3 s i o .a•� .B 1 o c .� FINE 1�" SAND IS1EPk`� i t 48 fs 10YR 518 per b r+ f 132» • El. 53' No Water Encountered 1 07111103 Revise SAS NO. DATE DESCRIPTION BY