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HomeMy WebLinkAbout0707 SOUTH MAIN STREET - Health 707 South Main Street, Centerville S//// �aEcrctto�o mo �° mm llll � z UPC 12543 0 �a No. R -OST.CONSJJ HASTINGS, MN j 11. Commonwealth of Massachusetts �8(O'" ob(° Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address r Gavin Owner Owner's Name information is regwred for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. A. Inspector Information Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 Cityrrown State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 16.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in'the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails awIl 0 2/25/20 Inspecto Ignature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Citylrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 I� Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �e 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/2 61201 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. City(rown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone 11 of a public water supply well t5insp.doc•rev.712612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City(rown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for au inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (if they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts �. ,F Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments �a 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ® Yes ❑ No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: Seasonal Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form I' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2018 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the 1/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: 1980 per BOH record with the addition of an infitrator in 2008 to expand the system to 4 bedrooms Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f Commonwealth of Massachusetts ,P Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 18"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) H-10 tank appears to be structurally sound If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000g Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle >12 11 Scum thickness trace Distance from top of scum to top of outlet tee or baffle >211 Distance from bottom of scum to bottom of outlet tee or baffle >2° How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts is p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): H-10 D-box is in good condition, 2' below grade, cover raised to 12" of grade t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments a 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ® leaching pits number: 2 ® leaching chambers number: 1 infiltrator ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/2 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts e Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): The pit labled as"C"on pg. 16 was excavated, it is 2'6" below grade, the bottom is at 4'6", it was dry, stain line 3"from the bottom of the pit. Ground water was found to be 3' below the pit. The infiltrator is labled"D" it was video inspected and is dry at this time. The pit labled as"E"was video inspected and is damp at this time. No indication of past hydraulic failure at any of the structures 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 'Official Inspection Form kvi�w' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C ILc�N T c � d C 3a C_ 3a 50 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts 1p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells 7'6" Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: 1980 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: TOPO mapping You must describe how you established the high ground water elevation: Augered a hole at the time of inspection and found groundwater at 7'6". There is a 3' seperation to groundwater at pit"C". Pit"E"was video inspected and is presumed to be at the same elevation. The infiltrator was also video inspected and is higher in elevation it is out of high ground water Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form kv�w Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the main house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria)and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 Commonwealth of Massachusetts (o Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address s Gavin Owner Owner's Name information is / required for every Centerville I✓ MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection ? r . 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. A. Inspector Information c5/4t yy03 Frank Nunes III Name of Inspector saa Company Name Box 841 Company Address East Falmouth MA 02536 City/Town State Zip Code 508.272.6433 13010 Telephone Number License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails 2/25/20 Inspector's Signatur Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 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: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2125/20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool l t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth.of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6° below invert or available volume is less than Y2 day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 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 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section CA. 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �e 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. CityrFown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for ay inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 l Commonwealth of Massachusetts re Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�e 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Citylrown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: Engineered plan on file Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ® Yes ❑ No Water meter readings, if available(last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: seasonal Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts �d Title 5 Official Inspection Form ' Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If.yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Pumped 2018 per owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ® Other(describe): Pump chamber Approximate age of all components, date installed (if known)and source of information: 2008 per BOH record Were sewage odors detected when arriving at the site? ❑ Yes ❑ No 5. Building Sewer(locate on site plan): Depth below grade: 18 feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: >10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 it Commonwealth of Massachusetts ,�F Title 5 Official., Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1500g/500g pump chamber H-20 tank appears to be structurally sound, inlet and outlet with steel covers to 1" of grade, pump chamber with steel cover to 1"of grade. If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500g Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle >12" Scum thickness trace Distance from top of scum to top of outlet tee or baffle >2" Distance from bottom of scum to bottom of outlet tee or baffle >2" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pumping suggested every 3yrs to prolong the life of the system I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of Inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts �. ,i� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): H-20 D-box 10" below grade, has steel cover to grade, very good condition I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts �m ,ip Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owners Name information is required for every Centerville MA 02632 2/25/20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): No adverse conditions observed * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 13x23 �I ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts ,IF Title 5 Official Inspection Form � Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leach field has 3 laterals, they were video inspected , no indication of past hydraulic failure, inspection port was dry, bottom of field is at 2' below grade, augered hole at time of inspection and found ground water at 6' 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 Commonwealth of Massachusetts �. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. There are 2 systems at this roe this is the carriage house ( Y property KY 9 ) Property Address Gavin Owner Owner s Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately lot -k t,�t�vSE Il� ��l�•c�uc`a�. 3 Lj a' 3 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ,v Ig Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 6'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. 2008 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: 4'seperation per 2008 compliance ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: TOPO mapping You must describe how you established the high ground water elevation: Augered hole at time of inspection and found groundwater to be at 6'. Bottom of SAS is 2' below grade Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments • 707 South Main St. (There are 2 systems at this property this is the carriage house) Property Address Gavin Owner Owner's Name information is required for every Centerville MA 02632 2/25/20 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Y Commonwealth of Massachusetts W Title 5 Official Inspection* Form' Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) � 0 OLQ( - � Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key j+3 Yt to move your Robert Paolini ; c cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC '� Company Name _ r tab P.O.Box 763 •' Company Address 01 Centerville Ma. 0263 Brun City/Town State Zip Cod (508)428-4028 S 14454 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 3/03/2008 Inspectors Srgn ure Date +e ' i 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. 707 S.Main(cottage)-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System form - Not for Voluntary Assessments M 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 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: ® 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 spetic system is in proper working order.at the present time. 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 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 15 1 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board.of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 707 S.Main(cottage)-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: `*This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 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. 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 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. ❑ ® 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- 1 0,000g pd. ❑ ® 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. 707 S.Main(cottage)-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 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 ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® El available as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ 'Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees,.material of construction, dimensions, depth of Liquid, depth of sludge and depth of scum? ® ❑, Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 707 S.Main(cottage)•12/07 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 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CM 15.203 (for example: 110 gpd x#of bedrooms): 220 Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available last 2 ears usage d na 9 ( Y g (gpd)): Sump pump? ❑ Yes ® No Last date of occupancy: unknown 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): 707 S.Main(cottage)-12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? _ ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (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: new system installed 2/28/2008 Were sewage odors detected when arriving at the site? ❑ Yes ® No 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: 1.4' feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 20'+feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): Depth below grade: 1 feet Material of construction: 2 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: 1500/500 H2O Sludge depth: 0 Distance from top of sludge to bottom of outlet tee or baffle na Scum thickness 0 Distance from top of scum to top of outlet tee or baffle na Distance from bottom of scum to bottom of outlet tee or baffle na How were dimensions determined? Tank empty 707 S.Main(cottage)•12/07 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 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 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.): Pump tank every 2 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank is structurally sound. 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.): P 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): 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 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 No 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.): Box is Ievel.Box has 3 outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 15 Commonwealth of Massachusetts N Li Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments ,M 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): All components are working properly. 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: 13'x23' ❑ 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.): No signs of hydraulic failure.System newly installed. 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville. Ma. 02632 3/03/2008 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.): 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer. Custom Ma Abutters Ma Size Zoom Out i In p p �� IJJ�J� T R. K 11 \ / .. £ J t . 1is 1rr - x' rr y r � f x n I Y C ' f x li \ r 3 // r � _ f f If +' 1, llf !f f f 1 1 f' fJ 0 2 Fee:V 1 f �. Set Scale 1" = 20 " I Aerial Photos (`nnvrinht 9r1ll r,_9M7 T^...n of P—Motile RAIA All rinhrc rac—, htt-P://www.town.bamstable.ma.us/arcims/apppeoapp/map.aspx?i)roT)ertvID=186066&mapp... 3/3/2008 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. (Cottage) Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 3/03/2008 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: Bottom of leachfield 4' 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: 2/21/2008Date ❑ 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: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations.USED:Plan on file with BOH. 707 S.Main(cottage)•12/07 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 ' Town of Barnstable �p 1HE?, Regulatory Services saxrvsrAsiE Thomas F. Geiler,Director MAM 9$ 1 `fig AtfO��A Public Health .Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 707 South Main St. 43CO Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC -- Company Name P.O.Box 763 Company Address , Alf v{ Centerville Ma. 02632 'ed011 Cityrrown State 2Zip Code 4.r, (508)428-4028 S14454 -- � Telephone Number License Number rld call r"+ 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 r 2/29/2008 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. """This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 707_s[l][1].main_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 15 i. - Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: The septic system is in proper working order at the present time. 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 exf]ltration 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 707_s[1][1].main_st.•08106 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 2 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown 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 �� Y" '_ ❑ obstruction is removed ND Explain: F .a` 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 yQ 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. 707_s[1][1].main_st.•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 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 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 El ® tributary to a surface water supply. 707_s[1]]1].main—St.•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 ^-cage. City/Town State Zip Code Date of Inspection 's r B. Certification (cont.) YY D) System Failure Criteria Applicable to All Systems(cont.): ,y. Yes No ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to an question in Section E the system is considered a significant threat Y Y Y4 Y 9 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. 707_s]1]]1].main_st.•08/06 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 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] f 707_s[1][1].main_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 av% Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?[if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage 2005:104,000 g ( y g (gpd))" 2006:200,000 Sump pump? ❑ Yes ® No Last date of occupancy: Unknown 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): 707_slt]f1l.main_st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? measured Reason for pumping: maintenance 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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: new leaching added on 2/28/2007 A ,F A Were sewage odors detected when arriving at the site? ❑ Yes ® No i ,L.; 707_s[1][1].main_st.•08/O6 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments L M , 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. CityrFown 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 ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10, feet Comments(on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'10"x57' Sludge depth: 8" Distance from top of sludge to bottom of outlet tee or baffle 22" Scum thickness 4" Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured 707 s[1][ti.main_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Pump septic tank every 2-3 years.Inlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness q' 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): 707_s[1][t].main_st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments G'M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 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 No 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.): Box is level.Box has three outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No L707� ][1].main_st.•08/06 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 11 of 15 i Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole s' Owner's Name �� y Centerville Ma. 02632 2/29/2008 �'� City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Vv/I i i Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: P Y Type: ® leaching pits number: 2 ® leaching chambers number: 1-quick 4 chamber ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Pits were dry at time of inspection.No visible stain lines observed.one new quick 4 chamber installed. I 707_s[1][1].main_st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Citylrown 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.): I 707_s[1][1].m&n_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Cityrrown 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. 707_s[1][1].main_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 2/29/2008 every page. Citylrown 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: Bottom of LP 4' 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: As-Built Card ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: f USED:Gaherty& Miller Model 12/16/94 ground water elevations. USED:USGS observation well data r a June 1992.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. ti i 707_s[1][1].main_st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 Town of Barnstable Op 1HE Tpk ' Regulatory Services BARNWABM ; Thomas F. Geiler,Director 3MAS& � aTED MA'S A Public Health .Division Thomas.McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future not does this Division agree with any technical observation s and interpretations contained within this report. In addition, by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the"Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. .I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. y1 16 M Property Address Kai Cole D Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Important:When filling out A. General Information . forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC Company Name reb P.O.Box 763 Company Address Centerville Ma. 02632 �70 City/Town State Zip Code (508)428-4028 S 14454 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 1 4 Z 11/30/2007 c ' Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Appro tng Auth`Rity(Board of Health or DEP)within 30 days of completing this inspection. If the system i_s` sharedcs�ystemor has a design flow of 10,000 gpd or greater, the inspector and the system owrMl shall submit the report to the appropriate regional office of the DEP. The original should be sA to the s tempwner and copies sent to the buyer, if applicable, and the approving authority. fGo ****This report only describes conditions at the time of inspection and under he corAMionftf use at that time.This inspection does not address how the system will perfor in the future under the same or different conditions of use. 707 s.main st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 15 Y Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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: ❑ 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 septic system is in proper working order at the present time. 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 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of.Inspection B. Certification (cont.) B) System Conditionally Passes (cont): ❑ distribution box is leveled or replaced ND Explain: ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ obstruction is removed ND Explain: C) Further Evaluation is Required by the Board of Health: ® Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply.. ❑ The system has-a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address . Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) C) Further Evaluation is Required by the Board of Health (cont.): ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Septic system is a 4 bedroom design.Actual number of bedrooms are 6.BOH has allowed owner to install a 2 bedroom septic system for carriage house. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No" to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow Required pumping more than 4 times in the last year NOT due to clogged or . ❑ ® q P p 9 Y 99 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. 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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. ❑ ® 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- 1 0,000g pd. ❑ ® 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 Il 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. 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 15 f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M01 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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 ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil:Absorption System (SAS) on the site has been determined based on: ❑ ® Existing information. For example, a plan at the Board of Health. ❑ ® Determined In the field (If any of the failure criteria related to Part C is at Issue approximation of distance is unacceptable) [310 CMR 15.302(5)] 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms (actual): 6 DESIGN flow based on 310 CMR 1.5.203 (for example: 110 gpd x#of bedrooms): 440 Number of current residents: NA Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 2005:104,000 g ( y g (gpd)): 2006:200,000 Sump pump? ❑ Yes- ® No Last date of occupancy: Unknown 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): 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) General Information Pumping Records: Source of information: ' Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single,cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (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: 1980 Were sewage odors detected when arriving at the site? ❑ Yes ® No 707 s.main st.•68/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °w 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line. 10, feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank (locate on site plan): ' Depth below grade: 1 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes. ❑ No -------------------------------------------------------------------------------------------------------------------------- Dimensions: 8'6"x4'10"x5'7" Sludge depth: 8,. Distance from top of sludge to bottom of outlet tee or baffle 22" - 4" Scum thickness Distance from top of scum to top of outlet tee or baffle 7" Distance from bottom of scum to bottom of outlet tee or baffle 13" How were dimensions determined? Measured 707 s.main st.•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 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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.): Pump septic tank every 2-3 years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears structurally sound. 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): 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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 No 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.): Box is Ievel.Box has two outlet laterals with equal distribution.No evidence of solids carryover.No evidence of leakage into orout of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No 707 s.main st.•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 M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 every page. City/Town 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: 2 ❑ 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.): Sandy dry soil.No signs of hydraulic failure.Pits were dry at time of inspection.No visible stain lines observed. 707 s.main st.•08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c,M 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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.): 707 s.main st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 15 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 707 South Main St. Property Address Kai Cole Owner Owner's Name information is required for Centerville Ma. 02632 11/30/2007 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: Bottom of LP 4' 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: As-Built Card ❑ Checked with local excavators, installers - (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: USED:Gaherty& Miller Model 12/16/94 ground water elevations. USED:USGS observation well data June 1992.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of ground water elevations. 707 s.main st.-08/06 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 15 I . . Town of Barnstable OF THE Tp� Regulatory Services snxxsrna Thomas F. Geiler,Director 9`bAMAM 1639. •0� Public Health Division rEDMp`lA Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 This septic system inspection report was completed by a private inspector who is certified by the State of Massachusetts, Department of Environmental Protection. Although the Town of Barnstable Health Division received the original/copy of this report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observation s and interpretations contained within this report. In addition,by receiving this report the Town of Barnstable Health Division does not automatically approve the number of bedrooms listed within this report. The actual number of bedrooms approved at a particular property would-be listed on the "Disposal Work Construction Permit". If you should have any questions regarding this report,please contact the certified Septic System Inspector who conducted the inspection. ` I ., TOWN OF BARNSTABLE od��LOCATION ?y —7 � SOU �Li�iq SZ- SEWAGE# J ?VILLAGE (Qn )yrVj Qz ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. 2.fr �/U I SEPTIC TANK CAPACITY J500 SOO H Zo LEACHING FACILITY:(type) ? oa k- (size) 13 X 2- NO.OF BEDROOMS Z OWNER 0.%, CU PERMIT DATE: COMPLIANCE DATE: c— Separation Distance Between the: f Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility y 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 T Ai 32 V A3 33 37.0 Q J `l TOWN OF BARNSTABLE �`-Al �U�' LOCATION �0 -7 A .yu�i Main Ttt SEWAGE# VILLAGE l 4grt �t vt 2I� ASSESSOR'S MAP&PARCEL INSTALLERS NAME&PHONE NO. C-cLI t LA)i dv Cn k V Z F qo 2 f_ T SEPTIC TANK CAPACITY 10007 a0.1 U LEACHING FACILITY:(type) '\4( size) a',K t� 3`y S.` NO.OF BEDROOMS y OWNER 6- PERMIT DATE: 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 E 3 Al 16, S � � jb.s 4Z x).& A 3 ry.q 1&3 J9.4 No. r si V / <' f � Fee l� oy THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ZIpplication for Diqoml stem Conotruction Permit Application for a Permit to Construct( ) Repair(J< Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. °�0 7 ou9'N yta% $TAT Owner's Name,Address,and Tel.No. , 70-7 5oor,4} N64rn S'i. Assessor's Map/Parcel (( L witU t t Installer's Name,Address,and Tel.No. C�Qaw,Oie E31TUSef Designer's Name,Address and Tel.No. r / ��2� P-v• ;0 - -Zr�3 Saa--2�3_ o3-71 2�Sy `i .rN 41� -z�32_ C-Asr wA%rr IYA o 2S3 Type of Building: Dwelling No.of Bedrooms 70 pyl Lot Size 21 i t LL sq.ft. Garbage Grinder ( ) Other Type of Building Z N ` No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided 221 • 3 gpd Plan Date 1 d-21-20 a1 Number of sheets Revision Date Title `707 S o�:k MAY,� Size of Septic Tank 1 jp p t,4;-0rj °" �T Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) TA441,, "P' C)La, r+,tf' lt ' Date last inspected: Z4.c 2vo Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board gfHealth. Signed Date !3 zoo Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. Date Issued No. ��� V Fee (/t/ i THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - T W Yes P U � TOWN OF BARNSTABLE, MASSACHUSETTS VYication for Oigpogal i§pgtem Con0truction Permit 'Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑.Complete System ❑Individual Components Location Address or Lot No. '7 0-1 5 ov pj a;1 5 rii-eT Owner's Name,Address,and Tel.No. l,/14, (0' 70-77 5u,,)rA MA,nS i . Assessor's Map/Parcel t$ G+n t C✓LLf t` Installerr''s/1Name,Address,and Tel.No. (h�W pae i.(4 0,%4V pAses Designer's Name,Address and Tel.No. .(,. C YjS ikaen,i4 . 1 -l . �t1Z►� Y J. cjJY 7roj SJ -Z�3- D ?1 �,�f�`I 7 4 CxMttv.n tic ���7Z G'Asr kv vc.i�� � o ZS3 Type of Building: w Dwelling No.of Bedrooms .fit. :,., Lot Size sq.ft. Garbage Grinder Other Type of Building 2 i�4w�'ikAmAti` No.of Persons Showers( ) Cafeteria } Other Fixturesi v• Design Flow(min.required) 12.120 gpd Design flow provided �?"; 3 gpd Plan Date i a-L Z-20 J) Number of sheets ( Revision Date Title '207 MOr, Size of Septic Tank 1 Qa sp4 SAgi-/to" Type of S.A.S. ` Description of Soil Nature of Repairs or Alterations(Answer when applicable) ,�! � Qu„,I p G,"4,11V L,Z� 5 Date last inspected: I)Q-L, ?.,Doi Agreement: The undersigned agrees to ensure the construction and maintenance'of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board �ealth . ` Signed Date. ZOof a? 'Application Approved by Date ;l. Application Disapproved by: Date a for the following reasons , Permit No. _ Date Issued:. THE COMMONWEALTH OF MASSACHUSETTS crr i BARNSTABLE, MASSACHUSETTS Certificate of Compliance 70 THIS IS TO CERTIFY,that the On-site Sewa Disposal System Constructed ( ) Repaired ( ,Upgraded ( ) Abandoned( )by caae ,J+4 n �( � (. .,.�r''+/ at P¢,7n S i �-(!v►t.t't� has been con •F cted`f cc rdance with the provisions of Title 5 and the for Disposal System Construction Permit No. t/ dated Installers dLg, ( #<-I j0/I ) C 1 Designer C. #bedrooms 'L Approved design flow AW gId -ue The issuance of/t/his ermit'hall not be construed as a guarantee that the system w' unction as dejsygned.Date ;/ Inspector i� J ——————————————————————————————— No. v �263 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE, MASSACHUSETTS Migonl �&pgtem Congtruction Permit Permission is hereby granted to Construct ( ) Repair ( r1� Upgrade ( ) Abandon ( ) System•located at r7,) l V-4 A, n 4.✓ LL- and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: Constructjon st be co pleted within three years of the date of this p it. Date Approved by f a % d McKean, Thomas From: McKean, Thomas Sent: Friday, February 22, 2008 2:30 PM To: Buntich, JoAnne Subject: 707 South Main Street Centerville The owner and the septic installer are eager to obtain a"repair"disposal works construction permit for the above- referenced property. It is located within the recently recommended DCPC area. The current septic system has enough capacity for three bedrooms (being approx. 20 gallons short for four bedrooms). The applicant is now proposing a repair permit by constructing a new two bedroom Title 5 system for the existing carriage house, consisting of two bedrooms, and by adding more leaching area to the main system. However after reviewing the file of applications for building permits in 1999 and 2000, 1 discovered that a health inspector did approve four bedrooms in the main house 1999, plus another two bedroom carriage house (which showed a cesspool behind it on the old plan) in the year 2000, totaling six bedrooms approved. I can't explain why the application for building permits were approved by the health inspector back then- as I became aware of this information recently. Is it okay to proceed ahead and issue the repair permit at this time? As I said the owner is eager to do the repair very soon as the house is apparently in the process of being transferred to another owner. (NOTE: The assessor's has this property listed as eight bedrooms). ' I 1 5 + McKean, Thomas From: Buntich, JoAnne Sent: Friday, February 22, 2008 2:36 PM To: McKean, Thomas Cc: Weil, Ruth Subject: RE: 707 South Main Street Centerville Tom, There are 2 areas of the DCPC with 2 separate lists of partial moratoria. If this is in the village area (purple on the map) expansion of septic capacity is not prohibited. I gave Dave Stanton the lists and map this morning. Let me know if you need more on this after you take a look at those. Thanks, Jo Anne. Jo Anne Miller Buntich Special Projects Coordinator Town of Barnstable Growth Management Department 367 Main Street Hyannis, MA 02601 p 508 862 4735 f 508 862 4782 Joann.buntich(a)town.barnstable.ma.us -----Original Message----- From: McKean,Thomas Sent: Friday, February 22, 2008 2:30 PM To: Buntich,JoAnne Subject: 707 South Main Street Centerville The owner and the septic installer are eager to obtain a "repair"disposal works construction permit for the above- referenced property. It is located within the recently recommended DCPC area. The current septic system has enough capacity for three bedrooms (being approx. 20 gallons short for four bedrooms). The applicant is now proposing a repair permit by constructing a new two bedroom Title 5 system for the existing carriage house, consisting of two bedrooms, and by adding more leaching area to the main system. However after reviewing the file of applications for building permits in 1999 and 2000, 1 discovered that a health inspector did approve four bedrooms in the main house 1999, plus another two bedroom carriage house (which showed a cesspool behind it on the old plan) in the year 2000, totaling six bedrooms approved. I can't explain why the application for building permits were approved by the health inspector back then- as I became aware of this information recently. Is it okay to proceed ahead and issue the repair permit at this time? As I said the owner is eager to do the repair very soon as the house is apparently in the process of being transferred to another owner. (NOTE: The assessor's has this property listed as eight bedrooms). I 1 I McKean, Thomas From: Buntich, JoAnne Sent: Friday, February 22, 2008 2:52 PM To: McKean, Thomas Cc: Weil, Ruth Subject: RE: 707 South Main Street Centerville Tom, I just looked at the spread sheets I sent over this morning. 707 South Main is in the Craigville Beach DCPC area where ability to expand septic capacity is limited. I think we may not be able to have instant answers to these questions going forward. Was the 6 bedroom septic installed? Is this just a repair or is additional expansion proposed? We need to look at what is in the ground in terms of capacity and what is proposed to be installed in terms of capacity. If they are not proposing any expansion to the capacity of the system they can go forward. If they are proposing an increase in capacity more analysis has to be done. Thanks for your patience. Jo Anne Jo Anne Miller Buntich Special Projects Coordinator Town of Barnstable Growth Management Department 367 Main Street Hyannis, MA 02601 p 508 862 4735 f 508 862 4782 joann.buntich(cD.town.barnstable.ma.us -----Original Message----- From: Buntich,JoAnne Sent: Friday, February 22, 2008 2:36 PM To: McKean,Thomas Cc: Weil, Ruth Subject: RE: 707 South Main Street Centerville Tom, There are 2 areas of the DCPC with 2 separate lists of partial moratoria. If this is in the village area (purple on the map) expansion of septic capacity is not prohibited. I gave Dave Stanton the lists and map this morning. Let me know if you need more on this after you take a look at those. Thanks, Jo Anne. Jo Anne Miller Buntich Special Projects Coordinator Town of Barnstable Growth Management Department 367 Main Street Hyannis, MA 02601 p 508 862 4735 f 508 862 4782 joann.buntich(aD-town.barnstable.ma.us -----Original Message----- 1 From: McKean,Thomas Sent: Friday, February 22, 2008 2:30 PM To: Buntich,JoAnne Subject: 707 South Main Street Centerville The owner and the septic installer are eager to obtain a"repair" disposal works construction permit for the above- referenced property. It is located within the recently recommended DCPC area. The current septic system has enough capacity for three bedrooms (being approx. 20 gallons short for four bedrooms). The applicant is now proposing a repair permit by constructing a new two bedroom Title 5 system for the existing carriage house, consisting of two bedrooms, and by adding more leaching area to the main system. However after reviewing the file of applications for building permits in 1999 and 2000, 1 discovered that a health inspector did approve four bedrooms in the main house 1999, plus another two bedroom carriage house (which showed a cesspool behind it on the old plan) in the year 2000, totaling six bedrooms approved. I can't explain why the application for building permits were approved by the health inspector back then- as I became aware of this information recently. Is it okay to proceed ahead and issue the repair permit at this time? As I said the owner is eager to do the repair very soon as the house is apparently in the process of being transferred to another owner. (NOTE: The assessor's has this property listed as eight bedrooms). 2 i r I own of bar>gsta me Wgulatory Services RR ®L[. Th6mas,F.Geiler,.Dirktur, , 1 S S BAA A � ` MAW Public health Division i �! Thomas McKean, irreetar i 200 Main Street,Hyannis,MA 02601 ' Office. 508.842,-4044 Fax: 508, V-G304 1. Installer & Deslgger Certification F6rni ' ±ry � t i L Date: �'� ? is i:Desi rier; _ SC-��..�� c�;���cr��, ;.,i4�� i Instal ler: c ecti�d�. L��LegX15es Address; �£�r� Grc �bc.;-r.�....N .�..�_ Address On.. g � � !Ul iZLOAM was issued a permit to install a (date) (installer) i { septic system a't m Q 7._. c,:th ;};f c�nj 5tt'e.e_1 based on a'design drawn by x (address') I f - rwi, C e.e q) -l r>c- _ dated ?fax e 7 ot'j"k V _ 1. certi#'y that the septic system,referenced above; was;installed substantially according to the design,iwhich may include rnirior approved changes such,as lateral relocation of the distn'.bution boir and/or septic tank, i Certify that the septic system referenced above',was; installed 'with major changes (1.c, greater#hart 1 Q lateral relocation,of the SAS or any vertical r®location of any component of the septic system) but in'acdordance with State & Local kiegulatinris. Plain revision or certified as-built by designer to follow CF JC7H er's Si to e) JR. Wt.: i 41807 (l�esigni s atuxe) f t�A Desi s Stamp Her ;. PLEASE TO BARNSTABLE QgBLIC REALTH: DIVISION. CERT 'I'E ; EILLNQP COMP EIS A - i LIC Tf DiVI N.BUIL RECEIVED BY THE! ABL _ ANK YOU Q. iicalth/scptic/nesit;ncr Conification Form I j i i 10 'd L9E0 i.Lz 80S ? 8NIZ133NI8N3af W*d 0b: V0 800Z-8z_a3d ' Town of Barnstable P# v Department of Regulatory Services : .w�rar�►.t; j Public Health Division Date lvlo� NAM i63P 200Wi Hyannis MA 02601 � Date Scheduled Time Fee Pd. D Soil Suitability Assessment for SeTeR al Performed By: iC�tl�e.� ism evl�d C 1 f CSC. " ` 7 Witnessed By: LOCATION& GENERAL INFORMATION Location Address Owner's Name t✓'A: 1'7 0`7 So��(N��, 5,7f�)�? � Address 0? 5 0 ✓h k1.1.� �T�`C�T Assessor's Map/Parcel: 19(� O G G Engineer's Name L'4(2ecv iCLe_ -t!7-7 4CIT-ek,, NEW CONSTRUCTION REPAIR V Telephone# 5^6tq-zg qv z_s Land Use s;agie F—i(x Slopes(30) 2- S Surface Stones yz5 Distances from: Open Water Body 7 130 ft Possible Wet Area 7�'O ft Drinking Water Well - ft Drainage Way 7 t 0 b ft Property Line 7 10 ft Other - ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands fn proximity to holes) S ee-- Q{{aclneq P1�n eta( El ec� " Q rCQo3 ed Sep'1C SYS t Ut,5,rate 4, cta kd Vece"Oec 27, 2G0 7 Parent material(geologic) OA wO s�, Depth to Bedrock y 10 Y 4 -6c, Depth to Groundwater. Standing Water in Hole: 7 b93 Weeping from Pit Face 0- 60 bqS r ' Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE <�_ > IA° Method Used: t14fC - d�46"LfaV \ tD Depth Observed standing in obs.hole: 7 fo Q In, Depth to loll mottles: N r in. Depth to weeping from side of obs.hole: # in, Groundwater Adjustment N!!} s Index Well# - Reading Date: -Index Well level Adj,factor, ,_� Adj.Groundwater Laval PERCOLATION TEST Datej1-10-d7 xtme 1604-4ti Observation ( !v:S� H { Hole# Time at 9" i Depth of Pere 28-Y y Time at 6" ll.0 2 MY Staff Pre-soak 75me @ /0.,30 AN 'lime(911•61) � 4 End Pre-soak is°yu210 Rate MinJlnch IV/ Site Suitability Assessment: Site Passed yes Site Failed: Additional Testing Needed(Y/N) AJ lkc Original: Public Health Division Observation Hole Data To Be Completed on Back----- /j, ***If percolation test is to be conducted within 100'of wetland,you must first notify the, Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORMMOC DEEP.OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. istenGravel) -/6Yr5/6 - s/-/ay G MS 2.5Y"A — — DEEP OBSERVATION HOLE LOG Hole# 2- Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. 28 to Yr - >y-roY "A. - - DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi t Flood Insurance Rate Man: Above 500 year.tlood boundary No Within 500 year boundary No= Yes Within 100 year flood boundary No— Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed ro osed for the.soil absorption system? �eS If not,what.is the depth of naturally occurring pervious material? Certification I certify that on 10"1-7-29 (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise and experience described in 310 C1v1R 15.017. Date i2-2$-o7 Signature4- . Q:1SEP'1 lCVERCFORM.DOC k5 210' 1Jtcparanon of Ylans.and Specincanui r• r r •. �, ".. r•, - r r - Thd plans and specifications for every on-site system shall be prepared.as follows: (1) -Every system shall be designed by a Massachusetts Registered Professional Engineer or,a'Massaclrusetu Registered Sanitarian provided that such Sanitarian shall nnt-design a. p an 2,000 gallons per day pursuant to 310 CMR 15.203. system designed to discharge more th C Any other-anent of t4a ovrner.snay prepare'plans for the repair of a system.designed to discharge not more than than 2,000 gallons per day pursuant to 310 CMR 15.203-provided they are reviowzd by.'a Massachusetts Registered Sanitarian and approved by the.approving . f authority;. (2). .Eyery,plan submitted'for approval must-be dated and bear the stamp and signature of - the (3p Every plan a new system or plan for the upgrade or expansion of an a isting:sj�sterri" - which requires a variance to a property line setback:distance,'must.-also reference-•a plan which bears the stamp and signature of a Ivlassacitasetts- Licensed Land Surveyor in accordance with M b.L. c: 112, ¢ S I D; 4a) Evtry plan for a System shall be of suitable seals•(one inch,=40 feet or fewer for plot ; s and one iiteit=20 feet or fewer for d etails of system.components). (gtd.shall.include. cd= of:the legal boundaries of the facility to be served: (b) the holder and location of any easements appurtenant to or which Could impact the system; (c) the local arrof the,all dwclling(s)or building(s.)existing and proposed on the facility - and identifieatiari of those to-be served by the system; ^(d) zfte'iaearion of existing or proposed irnper-i-ous•arcas,- incltrhrng:driyetiyays and •parking areas - - (e) location and dimcnsiorts of th'e'sgstom (including reserve area); (f). syst�rn design calculations,irielading design daily sewage flow, septic tank capacity (regtrircd and proyidcd); soil absorption system capacity (required and provided); and ' whether system is designed for garbage grinder, ( ) North arrow and existing and proposed contours; (h) location and of deep'obs.-rvation hair, tests including the date of test, existing grade elevations -marked on each test, and the names of the representative of the approving authority and-soil evaluator, (i) location and results of pezcolation'tests including the ante-of test and the names of 'the.representative of the approving authority and soil-,evaluator, . ()} name and certification number of the Soil Evaluator of record; (k) location.o£every supply,public a�sd'private, 1. within 400 feet of the proposed system location in the case of surface vc ater supplies and gravel packed public way supply wells, 2. withiii 250 f..et of the proposed system location in the case;of tubular public water supply arells, and 3. within 154 feet of- the Proposed-system.location iri the case of private water supply wells: _.. 1)' location of-any. surface waters of rile Commonwealth;rivers, bordering vegetated wetlands, ialt marshes, inland or coastal banks, regulatory floodway, yelocily zone, surface water supplies, taburaries to surface water supplies,certified vtzna.1 pools,private ' water supplies or.-suction lines, gravel packed'or tubular public water Supply wells, ' .. subsurface drains, leaching catch basins, or dry wells; and the location of any nitrogen sensitive area identified'in 310 CNS 15.215 withLl which portions of the proposed system ar6 located. (m) location of water lines and•other subsurface ntilides on the-facility-,ty; • (n) oascrved and adjusted ground-warn elevation in the vicinity of the system; o) a corplete profile of the system; (p) a note.on the plan listing al variances to the provisions of 310 C.MR 15.000 sought in ccnjtutction with the plan; (q) . the location and:elevation of one bcrdunark.within 50 to 75 feet it the facility which is not subject to dislocation or losi dining construcnon on:the facility;" 777 (r) when dosing is•proposed, complete design-and speciftcat_orr of the•dosing system proposed including.but not limited to dosing chamber capacity (required and:provided),' _dump curves and specifications, number.of d'esina cycles and depth per cycle; _ (s) when a Recirculating Sand Filter or equivalent alternative technology is required or Proposed, a complete plan and specification for the syste ,including a hydraclic profle; (t) a locus plan,to show the location of the Facility including the nearest existing s tee; (u) th sand fcon$tzvcuo'a a d the spec (v) the £�a�onshe cof the system. materials o A. 4 ��• ! / t��•III 1 NO LOCATION c SEW t ` V I L LA G,E I4 ll INSTA .LLERis NAME i ADDRESS JOHN A. AALTO.BACKH0E SERVICE West Barnstable, Mass. 02668 d U 1"LDER OR OWNER ,t �tll4a� ,r5 // or N -416,S.3 ``iDALE PERMIT ISSUE r k= DATE C0MPLIANCE � ISS l` D • s � r 5 , Yf • LOCATION SEWCVE PERMIT NO. VJLLAGE INSTA LLER'S NAME i ADDRESS yI JOHN A. AALTO BACKHOE SERVICE- b41�'r3�t�Eree� ', West Barnstable, Mass. 02668 BUILDER OR OWNER DATE PERMIT ISSUE y_s� _to DATE C0MPLIANCEnn I S S V D . _dC oAO �C - 30- - - - ,'V Me, A7 5� FEx.... ........................ THE COMMONWEALTH OF. MASSACHUSETTS BOARD OF HEALTH ----Town ..................OF..........Barnstable-------------------------------.---------------- Sl.IOJECT TO APPR®°-' �L Applira#ion for Dh4poii ai WorkEi -N 0�w. Application is hereby made for a Permit to Construct ( ) or Repair (Y ) an Individual Sewage Disposal System at: 707 So. Main Street Centerville , Mass. •.........................................•--•----........................................_....... ....--•••-•....---------•-••••••-••--•-----•-----••--•---•--•-••--•-----••-•-•-----•-••-•-••-..... _may Q ' Locatioi dress or Lot No. c� fvJl 4C.t1..... ..................... ..................................... ................................ ........._.... Owner 4 Address R' L . .... VI.............................................................•--•---- � Installer Address ' d 5 Type of Building Size Lot_.2.5..,2-4Q.........Sq. feet U Dwelling—No. of Bedrooms.._........3..............................Expansion Attic ( ) Garbage Grinder (ng Other—Type of Building ............................ No. of persons..._...__................... Showers ( ) — Cafeteria ( ) Q' Other fixtures ................................. . W Design Flow..................r�..5.....................gallons per person per day. Total daily flow--------------3-3-C.....................gallons. WSeptic Tank—Liquid capacitIQQQ---gallons Length.- '.6...... Width..4_1_1 0"Diameter________________ Depth_..r.!.(p x Disposal Trench—No..................... Width-..-__-__-_-:_-___-- Total Length.................... Total leaching area....................sq. ft. Seepage Pit No.----_2........_... Diameter-----12......... Depth below inlet....2.!........... Total leaching area..�02.......sq. ft. Z Other Distribution box ( X) Dosing tank ( ) aPercolation Test Results Performed by.Sa.pe...Clad...Sur.vey...CoriSultant§)ate_.---2/22/90---r-----..-. Test Pit No. 1-----a........minutes per inch Depth of Test Pit... ...6__....... Depth to ground water----8...6_.......... r3, Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q'+ --••-•-•-------------•-------•-•--...-----•--•-------••------•----•--••----•••--•----•-•---......•-------------•--•-----------------. O P ------............•--••- O Description of Soil. ,0-2_t 9 loam.... ......�.Q-. ..h___med .... el1Qw..sand._..wa_ter.. , w ..............••--••----.........------•--•-••--••--••--•--•--•-----------•----•-----•---------.._ ...• ' W •--•-•-------------------•----------------------•-----------......................-•--•--•------•-•----.......----------...--------••--........................•P��� u�lt U Nature of Repairs or Alterations—Answer when applicable._-________________ ` �� R�NWICK c ' - B. C ..,---------- - 0 ----CITAFIWAN-•• W Agreement: Z�� &' 6 gg, No. 27654 The undersigned agrees to install the aforedescribed Individual Sewage Disposal System .o �F rd i the provisions of'i T?E, 5 of the State Sanitary Code— The undersigned further agrees not t T in operation until a Certificate of Compliance has been issued by the board of health. Signed...................................................................................... ' Date Application Approved By- - r� -------------------------------- Date Application Disapproved for the following reasons----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------•----------------......------------.----•-•--------•-••---•-------•-••••-------••••-------•-••-•----•-----•-----•-••-•----...._.... Date Permit No......................................................... Issued--y P... Date No..a0 ,14 Fxs............................... THE COMMOfVWEALTlH OF MASSACHUSETTS BOARD OF HEALTH ...d:O} M. ..........................OF.........earwa4ab a------------------------..---.-.--------•------- ApplirFation for Displaii al WorkfiZomtrurtion Vamit Application is hereby made for a Permit to Construct ( ) or Repair kX ) an Individual Sewage Disposal' ,?System at: :i07 So. Vain Street Centerville,_ Mass. .................... . ............................................^............................. ................................................................................................... Location-Address or Lot No. +d1i. yo -....... .._...._ W ........... caner /��� 'Yy` � Address � Installer Address UType of Building Size Lot.2_5.,ZW, ----:....Sq. feet Dwelling—No. of Bedrooms..............3.....................:.,______•Expansion Attic ( ) Garbage Grinder (119, Other—Type of Building ___________________•-___-••- No. of persons............................ Showers ( ) — Cafeteria ( ) a Other fixtures ---------------------------------- W Design Flow.................5.5.....................gallons per person per day. Total daily flow-._•------•--3.30......................gallons. Ix Septic Tank—Liquid'capacit�Q !Q...gallons Length _ �lt.. .._... Width_.4..10 Diameter................ Depth--5__.14:-.__._ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No...... ............ Diameter...._ . ....... Depth below inlet....2._........... Total leaching area._3.02........sq. ft. Z Other Distribution box ( X) Dosing tank ( ) aPercolation Test Results Performed byC-a- C___-CS-d._Surma(.._Consult" ntgDate-----2/2.Z/8Q............... Test Pit No. 1....2.........minutes per inch Depth of Test Pit._8_._6?t-____-• Depth to ground water....8..6.• ....... _.- (Zq Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water--._-______-_-_-_-_____- tx ....................................................................................... O Description of Soil_O.s -2. •• 0 ?a.._.Z.-t9A.:.6..aed -...yYjj•9W- .3a�1d.._.RatBT' � g•6 x --- W LSH OF ............................•---......----•---••-•--•---------------------•---•-----••----•......--•••-•--•- U Nature of Repairs or Alterations—Answer when applicable....____,,. ----------a..... 'RENWICK ------------------------------------------------------------------------------------------------------•-•- -- •. ....... --........... Agreement: .....�� CHAPMAN Vi The undersigned agrees to install the aforedescribed Individual Sewage Disposal Sys tapMT 541 �i (^I:.:...TT ^ the provisions of ;. _ 5 of the State Sanitary Code— The undersigned further agrees not ¢� i operation until a Certificate of Compliance has been issued by the board of health. Fss/ONAL ENG\ Signed...................................................................................... ................................ r Date Application Approved By....... •.3�`2h _ �r r ' Date Application Disapproved for the following reasons------------------------------------------- -------------------------------------------------•••-•--•••------•--- .............................•----•-•••-••••--•--••••--••----•-••---•-•--••••••--•--...-•--•------••-•------•-•••--•••••-•••-••••••-•---•--••--•-••-----•-----••-•----•-•----••-...-•----•-•-•-•-•---•. Date PermitNo......................................................... Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .............OF....... .................................. (9rrtifiratr of Tootpliatta THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired by..............90-P------------ � Inst...................-----....... nstall--aller............................................................................................... at....................':�Ij::>_ _ ............ .�. i*5 ....... --.._.----- ' J' x•------------------------------------------------------------- has been installed in accordance with the provisions of TITLE j of The State Sanitary Code as descc/rri�bbed in the application for Disposal Works Construction Permit No------ _ _�...................... da.ted_- / ........... THE THE ISSUANCE OF THIS CERTIFICATE SMALL NOT BE CONSTR ED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTJO SATISFACTORY. DATE---.....Y.`.....��..' -----....---•-----------•-••------------- Inspector---------- .... *. ------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH woe OF......... , No.... ",/°3°l FEE........................ �i��ro��t� lark, �ona�trttrttion rrntit Permission is hereby granted............ 'two. ' -••------------------------•----------------------••-------------..------------------- to Construct ( ) or Repair ( � n diivvidual Sewage Disposal System Street as shown on the application for Disposal Works Construction Permit No.._.__f� �____ Dated_____________�__�'Q-�.... -------•--------------------- ------ --- ---- � -------------------•------------- and of Health DATE........................ .................................................. FORM 1255 HOBBS.& WARREN, INC., PUBLISHERS c 063 L a � , Ln U N v W 1Di O Q U N 0- 9 }- m @ , u AS25 n � a m Q O EXISTING DN to z c� _ } 8 t SCREENID PORCH `r m I 0 E(LSTING (VERIFY DUSTING PLATFORM) I- LDN 5.5') WOOD DECK 4XG P05T5 m TING I PROPOSED (REFUGE PX15T.PU 10-1 E K DECK Q UP I N III FXISIING I EXISTING ANMING WOW 4.4 TUBE 6T1. O4B'DOUBU:DOOR `4x4 TUBEx 57L. `d �' DINING LIVING ROOM (3)s 14°LVL HEADER N f::-- 2%6 P.T.WAUS 16'O.G. DN 5 M r I UP I2• PROP05ED q= SneD ROOF I IIP GARAGE ED W&FIRECODE CEILING) OU15TING Xo xo 17 BATH FAMILY ROOM p ® I ® 3 I ® g -J w UP 12R I � - W O K I� FUEf RNACE I m i n -- I EXISTING ®� (S)2XG (S)2X6 EXISTING NNDER WALL ABOVE) (UNDERWAILABOYE) M v W KITCHEN ® SITTING (3)t-3/4'•X 8IA."LVL �— (3)1-3/4"%9 t/4"LVL 'r U ® —— qxq TUBE STL 4.4 TUBE STL _ _ " O V --- — --------- -- --------- --------- PANTRY B4B•OVERHEAD DOOR ti I (CONTINUOUS) I B4B OVERHEAD OOR I I (3)2Xt0 DR HDR 1 L----(3)1-3/4"X87/4"LVL----J� (3)2X10 DR DR W OO9'x9.OVERHEAD DOOR I p —————————————————— _ a EXISTING W O ENTRY ? A. Oz sz W As < w IL 3 zz EXISTING Z , tu DECK a � tu- Q K LL O � _ cz LLJ V G V I "OF 1l� z ? 00 FX15TING HOU5E AND DECKS - v i z O Q ADDITIONS C� rp^�^ pp®®RR NEW C13�I9x1tJ LlJ r tL g SA GH W p o PROPOSED U STREICTURAI 0 F FI R 5 T FLOOR PLAN , No.32789 a F A� C reQ� DATE: 05/07/14 114" NAL SCALE: 1/4"=1'-0" 4 6 DRAWING#: THESE PLANS ARE IN COMPLIANCE WITH THE MASSACHUSETTS STATE BUILDING CODE SEVENTH ADDITION / 110 MPH WIND ZONE A3 N -H N t e rJ V1 l N �' N LJ � f c = N S2 +, �� @ m 5 EXISTING A 5 < V J E m ROOF DECK O) 2,_4. 10'-3 112° G-2" 5'-5 1/4" 5-G 3/4' 0 N UP 3• UP 3' — I ro ON PROP SEO I I in aq BA L ONY o 3° STUD POCK T I EXISTING N I n I BEDROOM I OOM (PLATFORM) ____ ----- ------ 7pwPO5ED g PROPOSED CL I EXISTING I UTILITY MASTER BEDROOM BEDROOM n CL j BUILT-IN BDILTIN I I PROPOSED I I------- J' FAMILYROOM_ a a..- SNED ROOF a y , TKJ�7ri BATH �+�, 19'G'X 2T O hb')O I Ni N EXISTING S b 1 m a I �I-�♦ . M.BATH i RIDGE LINE _ u I o I I STEP �J / `\O � n _3 A p - —.I 4XG AXs I I it � __ _ r • I BATH }� I � ® O O I m 66 I ON cI,., 2�� PROPOSED I > O CL CL CL BEDROOM o CL - F I EXISTING _ I I SITTING i EXISTING W BEDROOM (7'-3'CEUNG) ------------------ ------ ---1 EXISTING �. — ._______ — 1 BEDROOM 51-OPEDCEIL114G p I I —_-- z ON ll_I z L————— I I3°STUD POCKET p _______________J_ ______ _________ —J 2'-4" 5'-G° 4'-2" T-G° T-G" 4' LUI-l i— --__—_�__ 2 56 24 EX15T1.\'G I j O LOFT (G'-10'CEILING) I u-i LL I N 5 5 )2'-O" 15'-0' 1LL- 2'O" ; 0 I UJ z Q . W z Ss " O EXISTING HOUSE NEW ADDITIONS Q ILI Z p LL1 2 T) PROPOSED PROPOSED TOTAL PROPOSED ADDITIONS z O SECOND FLOOR PLAN SQUARE FOOTAGE SQUARE FOOTAGE z o 0 w � 1/4"=F-7' LIVING SPACE 4,168 SO.FT. LIVING SPACE 1,020 SQ.FT. w p 1 z 4 SCREEN PORCH 420 SQ.FT. BALCONY 171 SQ.FT. LU O LU — 688 SQ.FT. GARAGE 1,088 SQ.FT. a F BALCONY A IRS 171 SQ.FT. DATE: 05/07/14 GARAGE 1,088 SQ.FT. SCALE: 1/4"=1'-0" DRAWING#: THESE PLANS ARE IN COMPLIANCE WITH THE MASSACHUSETTS STATE BUILDING CODE SEVENTH ADDITION / 110 MPH WIND ZONE A4 ® 7 s t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# �D „ -7 Health Division ���, � � l �5~ Date Issued 9P L,-�&� Conservation Division _j1ljZ _. Feeo�N O� Tax Collector jlZ/tx� (�z Treasurer ► a, L � �—z /�'�� �Z '�Z> rr}� �I� g `'� l ,-4 PlanningDept. IT y c.. Date D. finitive Plan Approved-by-Planning BoardLi Historic-OKH Preservation/Hyannis Project Street Address 7/) : Sd z % z2&. 11,J 7—(�&Z/? Village Owner C Address 707 S. MAIGV s i, Telephone 3/6 — 6 7 �? Z" Permit Request i Square feet: 1st floor: existing 9,proposed -3eLm-e-. 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathiered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family C/ Two Family Cl Multi-Family (#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes Zo Basement Type: ❑ Full ❑Crawl ❑Walkout W tither A 0 11-e— Basement Finished Area(sq.ft.) '^ Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half: existing new - .Number of Bedrooms: existing new Total Room Count(not including baths): existing new�_ First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil CB Electric ❑Other Central Air: ❑Yes ZN Fireplaces: Existing N,e w Existing wood/coal stove: ❑Yes O'No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn: ❑existing ❑new size Attached garage:Cl existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name r / Telephone Number .Sv— yaf—" cl _ Address T�� _ License# Improvement Contractor# Worker's Compensation# 'INSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE / 'Engineering Dept. (3rd floor) Map �� Parcel G(p(p Permit# House# Date Issued IDl r _ w Board of Health(3rd floor)(8:15-9:30/1:00-�30) �''— Conservation Office(4th floor) (8:30- 9:30/1:00-2:00) 1 A-i of n ewJ, Planning Dept. (1st floor/School Admin. Bldg.) �1HE Definitive Plan Approved by Planning Board 19 SEPTIC SYSTE BALLED IN C !JAG S��� WITH TIT L p'°�e W� ,0 q�3 I o$�7 B TOWN OF BARNST ENTAL C E ND Building Permit Application T �`' H1 i"E117,UL '°s h�� + Project Street AddressfA Village' 4(v i Ite- Owner 3DSS gakh U °4- C.1 t i_(j Address F000 N wr\u( vr, , L O s A-A e S� Telephone ��/U 1 S o)10 ' Permit Request 94-Z,CJL. -1- Sc.t� e.'\ � a,-.> hi-ee,.. .'t 'Q. -"y 16 7K,z.�C &-O o iTt u� 1 Q._ !Q� �� 5` ✓ADC L�GV1 S'1C.. r l� l)!L� ^'. ,/j- r-io O �� \ t C` &a X ^06k' + heal*- M-kkoz F -v�ae_ a-• c0�..w , First Floor /S 5/� uare feet Second Floor / � square feet Construction Type Estimated Project Cost $ 0?0U 000 00 Zoning District ,L'5M1A4A Flood Plain " 414t Water Protection /UQ Lot Size_ o2 , u,S- -k' Grandfathered ❑Yes ❑No Dwelling Type: Single Family 5Y Two Family ❑ Multi-Family(#units) Age of Existing Structure 0 0 'F Historic House ❑Yes Id No On Old King's Highway ❑Yes ANo Basement Type: 3 full ❑Crawl Er Walkout ❑Other Basement Finished Area(sq.ft.) /3 y Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing i .Q� New No. of Bedrooms: Existing New Total Room Count(not including baths): Existing q New First Floor Room Count__ Heat Type and Fuel: El"Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing a2 New Existing wood/coal stove ❑Yes Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes 51 TO If yes, site plan review# Current Use SIA Lc, ^111!J Proposed Use �S dw► Builder Information. Name /'�j�,f�G�� J(/J-P1 Telephone Number S D$ Address Z nj LA G,�C�m -i y1C�I(f{,td �,License# C S U �- Fos L,5r t1d W c/ An S3 7- Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ;e So LI � SIGNATURE DATE i /2 1 g BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �7.IMI PY �o r lIIAr rf f nn ���► - /t7G'r �a.�a,: Fes'iG T.CL1/C 41, w 7- 7/c 1 lz* ix 410 j. ! }* J T!✓.M/A/C'>11.5 )/A YIFW J T9 B — s- `'� �, _ A� 9X9y ale C�AaI 76 EL '-0 796 61 I � 25,2�U 5Q FT. t t � eE4. 41,7 1 J 4x7 � sS �. 1 � I Box I BGGIckE1.�G6 t , /z 3 sm / ' ltNK /Z � r � ♦ '- AXL ALE t ,aI T. ��c/ .5 h''ETC-H � `i•� z - Fav°v�7�o.v �1 %-Z"e 3 ` . G/ia�r8<� ilk {N 0 0 'sroQ �T/MA TElJ L7A/L Y FL 0N1 � � � Tc>�O o o:��c? ✓,e.,��,g j / '�. C 3} .404ZLMS(/V0 Cc►/2BA6E GI�vvE E? dL p4 Y/6• Gt. - 330 7 2J MAX A GG UW<?BL E F1 a r v A-C,E' 807TDM //3.5 F, x 3✓7L� F ri NWKA SOIL LOG AI ♦a 7,9 ° __7 - ao 4 EL &VATiON SCHEDULE a PROPOSED SITE PLA9 IH6ra 1. INv AT FO VNDAT f ON , 4 SEWAGE 3YSTEM DESIGN Z. INV INTO SEPTIC TANK 1G? ��? ?y 0N v o T OF 5 5 P T I c 7 eMx v` �'✓l.�i i.. �T ;r I ; 4. 1N ✓ INTO DISTRIBU-rION 5 INv OUT OF DISrR18vTION ?,,DX PERC. RATE : < ti'f,; />t c, i � Y COWSULTANTS (a WY INTO 'SEEPAG6 PIT . -_ �3 CAP& COD 5URvg 'E 5T 6T : _;:_ ' IZOUTr. 132 TOMfN INSPECTOR: -i:o- L sSt'(Jf:'�<1 r' 7 BOTTOM OF PIT , 5 wV'ANNIS,MASS. SAC 6L WOE OP;kpwi•,Q ram TEST )Aapi pyy; OF STOQrG LAYE9 5 53 k V FFE- 8.0'± PROVIDE CAST IRON FRAME& FINISH GRADE OVER D-BOX= 9.0'± GENERAL NOTES - COVER OVER H-20 CONCRETE 3/4"TO 1-1/2" DOUBLE WASHED STONE TO CROWN OF PIPE RISER FOR INLET, CENTER& FINISH GRADE PLACE CAST IRON FRAME& COVER TO OUTLET COVER TO F.G. OVER TANK EL.= $.2'± F.G. OVER H-20 CONCRETE RISER 2"OF 1/8"TO 1/2" DOUBLE WASHED STONE �+ _ 9.8'+ 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE @ FND. EL.= 7.5 ± . FINISH GRADE OVER LEACHING FIELD= 8.9 - 4" SCHEDULE 40 PVC MIN SLOPE 1% ° METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL -- f - ( 5" DIA. OUTLET(S) SLOPE @ 2/o MIN. OVER SYSTEM CODE AND ANY APPLICABLE LOCAL RULES. 2a"MIN.ACCESS 9"MIN. f -- 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 6.92' COVER(TYP 3) 36" MAX. r ACCESS BOX WITH COVER TO GRADE DESIGN ENGINEER. ' JOINTS TO BE (SEE NOTE 21 PROPOSED 4" I PROVIDE H-20 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL PVC SEWER PIPE 3"-- WATERTIGHT(TYP) SYSTEM UNLESS OTHERWISE NOTED. MIN. 1%SLOPE 6" 3" g° i CONCRETE RISER PERFORATED PIPE SLOPE AT 0.50 , 2 MIN. _ PROVIDE WATERTIGHT TOP OF S.A.S. _ 8.12r _ 8.00 9"MIN. 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 3" MAX. JOINTS (TYP.) 36 MAX. ELEVATION =8.12' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. PROPOSED 2" FM TO 6.00 14" LEACHING FACILITY ' 2" PVC IN FROM UNLESS A 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND 5.75 SEPTIC TANK 4" PVC OUT TO j THE TOP OF THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. e i O LEACHING FACILITY 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 5.25 48" 12„ , 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. 11.8' 7•90 MIN. 7.73 0 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK 22"ZABEL FILTER** MODEL#A1801-4x22 6" CRUSHED STONE °° 6" PROVIDE TEEM�3 I 7.50' EFFECTIVE ; FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS OVER MECHANICALLY _ o o I DEPTH NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH 0.96' COMPACTED BASE 7.62' BOTTOM OF FIELD TO BE LEVEL EL. = 7.00' J AND DESIGN ENGINEER. 6" CRUSHED STONE 5 OVER MECHANICALLY OUTLET DISTRIBUTION BOX 3' 3.5' 3.5' 3' 8- ELEVATIONS BASED ON 1929 N.G.V.D DATUM OF 10.78' ESTABLISHED ON A COMPACTED BASE TO BE INSTALLED ON A LEVEL STABLE 23' NAIL SET IN UTILITY POLE#39/191 AS SHOWN ON PLAN. PROPOSED 1 ,500 / 500 GAL. 2 COMPARTMEN ** BASE. FIRST TWO FEET OF OUTLET 13' 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION TEE w/FILTER SHALL E PIPES TO BE LAID LEVEL. * e THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT H-20 CONCRETE MONOLITHIC SEPTIC TANK PLACED DIRECTLY UNDER GROUND WATER ELEV= 3.00 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES LENGTH 9.96' WIDTH 5.88' DEPTH 5.96' CEN"-ER COVER OPENING CROSS SECTION VIEW 4' MIN. TO THE DESIGN ENGINEER. NOTE: YANK DIMENSIONS PER DISTRIBUTION BOX (H-20) DETAIL TYPICAL FIELD PROFILE FIELD DETAILS 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONCRETE SEPTIC TANK PROFILE WIGGINS PRECAST CORP. NOT TO SCALE FIELD END VIEW * See monitoring well data on plan - - STRUCTURES SHALL BE MADE WATERTIGHT. NOTE: 1.) MAGNETIC MARKING TAPE SHALL BE ' NEMA 4 JUNCTION BOX CORROSION RESISTANT& INSTALL 1-1/4" PVC TO HOUSE. JOINTS TO BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING LIQUID-TIGHT CABLE CONNECTORS SUPPORTED WIRE PUMP AND FLOATS TO SIMPLEX CONTROL PANEL No. 1-CC2 �` T SC+4 E • ••+ TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM PLACED ALONG THE TOP EDGE OF EACH j CONNECTORS SUPPORTED BY 1-1/4"PVC CONDUIT, NEMA-1 MFG. HOOVER INSTRUMENTS. '`�� SEPTIC SYSTEM COMPONENT. APPROPRIATE AUTHORITY. JOINTS TO BE MADE WATERTIGHT HOISTING CABLE 7 x 19 STAINLESS STEEL �; `� • - 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS a .:. INSPECTOR: Donna Miorandi 1/8" DIA. / 1,760 LB. STRENGTH , LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE 2.) CONTRACTOR TO VERIFY SOIL •�' 2"BALL VALVE w/ UNIONS SCH. 80 PVC f! --- - • �'• . , _"� 0i' EVALUATOR: Michael Pimentel, E.I.T. CONDITIONS IN THE LOCATION OF THE l - t �� ep • •e DATE: 1 THEY SHALL WITHSTAND H-20 LOADING. GEORGE FISHER CO. MODEL NO. 560 • �` t�( - # • December 20, 2007 PROPOSED LEACHING FACILITY TO ENSURE in ---° - • 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. CONSISTENCY WITH TEST PIT DATA SHOWN 3" 2"SCH. 40 TO D-BOX L 4 • • 10 ' e TEST PIT#: 1 4 _ i s • . _ 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE N THIS PLAN. REPORT TO ENGINEER AND PROP. 1 QUICK _ "SCH. 40 TEEw/CLEAN-OUT CAP ti o. �=� ELEV TOP 8.00 / STANDARD INFILTRATOR ° _ ALARM ON ,- • ' Q ' •� �lr• c� MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. LOCAL BOARD OF HEALTH IF SOILS ARE 3 -v--� • '+ •' ' T +� �.,��''•.�•.++., •. ELEV WATER= 3.00' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, NOT CONSISTENT WITH TEST PIT DATA. UP 39/190/ PROP. ACCESS PORT in I • `'�: '•'• +t re FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). co LIMP ON 1/4"WEEP HOLE IN DISCHARGE PIPE PERC RATE - 4 m I Al PROP. INSPECTION PORT - - �� Co PUMP00 2" BALL CHECK VALVE SCH. 80 PVC 100 " •' - 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN Public �+ DEPTH OF PERC = 28"-46' SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. cXISTING SYSTEM FOR OFF P.S.I. FLOWMATIC MODEL No. 208S �� f co �O / ° N MAIN HOUSE TO REMAIN _ Landing TEXTURAL CLASS: 1 16. PROPOSED PROJECT IS LOCATED WITHIN: 1/4"WEEP HOLE IN DISCHARGE PIPE ° (2)WIDE ANGLE CONTROL FLOATS C° i �'f.• ' ASSESSOR'S MAP 186 PARCEL 66 °j (BARNES 073618) 2"SCH. 40 PVC DISCHARGE PIPE 5.�',-' ` OWNER OF RECORD: KAI COLE ° LOCUS OJT �� W W 1: PUMP ON/OFF 120 ACTIVATION ,r - " ,,.f' { 0" 8.00' V 3/ /fi �\ 2: ALARM ACTIVATION BARNES SE411 PUMP 0.4 H.P. 115 V, 1750 RPM, 2" t. 3 - A ADDRESS: 1000 AMHERST AVENUE J h� �� ? P ) s ci _ DISCHARGE PASSING 2" SOLIDS (IMP. DIA. =5.44") I, ' , ' Fill LOS ANGELES, CA 90049 O o o ,� 15001500 GAL. 2-COMPARTMENT H 20 .:. ,� 28" 5.66' Q / .� / - j .? . t FEMA FLOOD ZONE B &A13 (EL. 11) (� p ,� S Perc S , CONCRETE MONOLITHIC SEPTIC TANK R COMMUNITY PANEL# 2500010016D REMOVE ALL UNSUITABLE C� / \ti�^� (8 7 NV.(a")(out)=a 13' `�' 7�9 �7), NOT TO SCALE / ��`1 j 46 Loamy Sand 4.33' O ^� HC 3 ` 2p, F __ _ _ C .L% R j B 17. DEED REFERENCE: 10 Yr 5/6 MATERIAL TO B-SOIL& REPLACE o r �. . ----- - L.C.C. 164975 WITH CLEAN COARSE SAND SWING-TIES #707A „ 18. PLAN REFERENCE: PROPOSED INSPECTION PORT ° O ( ) BUOYANCY CALCULATIONS \� \ / LOCUS PLAN 54 r 3.50 L.C. PLAN#31731-B #707A HC 3 HC 4 1500/500 GAL. 2-COMPARTMENT H-20 CONCR. MONO. SEPTIC TANK : 60„ Weeping c0 _ 3.00' PROPOSED 13' x 23' EXISTING co DESCRIPTION 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. ELEVATION OF HIGH GROUNDWATER EL.= 3.0 ± SCALE: 1" - 1000' LEACHING FIELD /O `�- 4-BEDROOM / � � - p. 6 BEG. INFILTRATOR(7) 39.3 44.2' BOTTOM OF SEPTIC TANK EL. = 0.96' 20. PROPERTY LINE INFORMATION IS ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY Benchmark (5 _�3 v �/ DWELLING 38.0' 42.7' WATER DISPLACED = (3.0' -0.96')x 9.96'x 5.88'= 119.5 C.F. FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL NOT ASSUME ANY LIABILITY 0 Q" O , / END INFILTRATOR(8) WEIGHT OF DISPLACED WATER = 119.5 C.F.x 62.4 LB/C.F. = 7,455 LEIS DESIGN DATA (#707B DWELLING) Medium Sand FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. Nail in U.P.#39/191 , -fir'_=-_::��- � I _ � z. / WEIGHT OF 1500/500 GAL. 2-COMPARTMENT TANK= 16,000 LBS± Elev. = 10.78' ! _f 24 8, HC 4 O O NUMBER OF BEDROOMS (DESIGN) 2 C 2.5Y 6/6 1929 N.G.V.D. �' - ': 1) V`�� / VOLUME OF SOIL ABOVE TANK= 9.96'x 5.88'x 1.25' (SOIL)= 73.2 C.F. 21. A 4" PERFORATED SCH. 40 PVC PIPE SHALL BE PLACED IN A VERTICAL POSITION TO A 4 <-J - '= 1$ O / DESIGN FLOW 110 GAL/DAY/BEDROOM ( I'-; � 1 'y''1 � Q �' f WEIGHT OF SOIL ABOVE TANK = 73.2 C.F. x 110 LF/C.F. = 8,053 LBS± DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3" OF FINISH GRADE. A 16,000 LBS +8,053 LEIS = 24,053 LBS±> 7,455 LEIS (ACCEPTABLE) TOTAL DESIGN FLOW 220 GAL/DAY REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TO ALLOW FOR INSPECTIONS. / LSA - -' 2) DECK / - DESIGN FLOW X 200 % = 440 GAL/DAY ( 3) w /f PROPOSED H-20 HC 1 / / USE PROPOSED 1500/500 GALLON SEPTIC TANK/PUMP CHAMBER DISTRIBUTION BOX -- `' A / h e e 104" -0.66' �800, INSTALL A 13' x 23 LEACHING FIELD LEGEND CRUSHED #707B ACCESS PORT w/ INSPECTION PORT w/ACCESS BOX " See monitoring well data on Ian f I F.G. EL.= 10.5 ± SIDEWALL CAPACITY STONE � j EXISTING / ,' / � BOX TO GRADE WITH COVER TO F.G.(SEE NOTE#21) --- g--- --P - r` DRIVEWAY Tp 2 / 2-BEDROOM __ _ NO SIDEWALL AREA CREDIT TAKEN - - 50 - - EXISTING CONTOUR 8.00' DWELLING EXISTING PLUMBING / 1.1' MULTI-PORT , BOTTOM CAPACITY TEST PIT DATA 50 PROPOSED CONTOUR FFE - 8.0'± CONNECTION TO MAIN / MAP 186 END CAP (TYP) TOP OF SAS = $.00 GROUNDWATER HOUSE TO BE / /BREAKOUT (LENGTH X WIDTH)X(0.74 GAL/SQ.FT.)= SQ.FT. ``�. HC 2 / 4"SCH. 40 PVC INSPECTOR: Donna Miorandi - ❑/H/W EXISTING OVERHEAD WIRES MONITORING WELL 6� -DISCONTINUED AND PARCEL 65 13' x 23' )X (0.74 GAUSQ.FT.)= 221.3 GALLONS/DAY TOP EL.=11.30' / RE-ROUTED TO N/F ROMPALA MIN. SLOPE 1 EVALUATOR: Michael Pimentel, E.I.T. C EXISTING UNDERGROUND CABLE ^CAL T`a PROPOSED SYSTEM0, TOTALS: DATE: December 20, 2007 E/T EXISTING UNDERGROUND UTILITIES (TYP.) o o TOTAL LEACHING AREA 299.0 SQ.FT. TEST PIT#: 2 JQ PROPOSED 1500/500 GALLON / / o oo GAS EXISTING GAS LINE - TOTAL LEACHING CAPACITY 221.3 GAL./DAY 2-COMPARTMENT CONCRETE l / /'� MAP 186 ELEV TOP= 8.00' W W EXISTING WATERLINE MONOLITHIC SEPTIC TANK �/ 7.66' ' DOSING & STORAGE REQUIREMENTS ELEV WATER= *3.00' EXISTING FENCELINE PARCEL 66 / 7.00 (flat) 2.83 DESIGN FLOW: 220GPD -X-X-X-X-X- APPROXIMATE LOCATION OF gyp/ f Z DOSING REQUIRED: 4 CYCLES/DAY TEST PIT LOCATION 0.55 Ac± 4.0 PERC RATE _ EXISTING ELECTRIC LINE TO BE "� (PER ASSESSOR) 220 GPD/4 = 55 GAL/CYCLE RE-ROUTED AWAY FROM SDS 5 -2'TOTAL INFILTRATOR END VIEW DISTANCE REQUIRED BETWEEN PUMP DEPTH OF PERC = LP EXISTING LEACHING PIT GROUND WATER ELEV.- * 3.00' ON AND PUMP OFF FLOATS: TEXTURAL CLASS: 1 So _ 55 GAUCUSE 0.50'TO PROVIDE FOR BACKFLOW)LE O � O PROPOSED 1500/500 GAL. 2-COMPARTMENT ONE -QUICK 4 STANDARD INFILTRATOR(PROFILE) ( H-20 CONCRETE MONOLITHIC SEPTIC TANK FLOOD ZONE � STORAGE REQUIRED ABOVE WORKING LEVEL: 220 GAL. 0„ 8.00' PROPOSED 2"SOLID SCHEDULE 40 PVC PIPE " ONE - QUICK 4 STANDARD INFILTRATOR DETAILS DELINEATION BASED / STORAGE PROVIDED ABOVE WORKING LEVEL: 313 GAL. A ON FEMA PANEL W ce)w / ?w�- SM 1 NOT TO SCALE FIII PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE „ O Q Q / ~�� DESIGN DATA (#707A DWELLING) 28 5.66' _ PROPOSED 4" PERFORATED SCH. 40 PVC PIPE N Z Q�' MAP 185 / /� \ ❑ PROPOSED H-20 DISTRIBUTION BOX MONITORING ON �%�/ / DWELLING PREVIOUSLY DESIGNED FOR 416 GPD BASED ON APPROVED Loamy Sand PARCEL 11 <<!i PLAN DATED FEBRUARY 1980 PREPARED BY CAPECOD SURVEY B 10 Yr 5/6 Q PROPOSED QUICK 4 STANDARD INFILTRATOR WELL DATA �p/OF N/F BAGLEY \�P�`,`, SM 2 , SWING-TIES (4707B) CONSULTANTS ON FILE WITH LOCAL BOARD OF HEALTH. p �O 1 2-21-08 MCP JLC ADDED INFILTRATOR; M.W. INFORMATION, ETC. Q' PROPOSED INFILTRATOR WAS DESIGNED TO MAKE UP THE 54" 3.50' ELEV TOP OF WELL PIPE = 11.3' QQ .�\P� DESCRIPTION HC 1 HC 2 REV. DATE BY APP'D. DESCRIPTION _ DIFFERENCE BETWEEN THE APPROVED DESIGN FLOW (416 GPD)AND Wee In 60" - - ! READING# { READING# 5 / Q �/ SEPTIC TANK(1) 16.5' 37.2' THE REQUIRED TITLE V DESIGN FLOW(440 GPD) FOR A 4 BEDROOM 60" = 3.00' PROPOSED SEPTIC SYSTEM UPGRADE i DWELLING. THIS METHODOLOGY WAS APPROVED BY THE LOCAL DEPTH OF WATER= 8.5' DEPTH OF WATER= 8.35' SM77 / SM 3 20.8' 30.2' BOARD OF HEALTH ON FEBRUARY 20, 2008. PREPARED FOR: ELEV WATER- 2.8' ELEV WATER- 2.95' `� / �. SEPTIC TANK (2) DATE&TIME = 2-20-08 @ 11:00 A.M. DATE = 2-20-08 @ 12:15 P.M. f �SM 6 LEACHING CORNER(3) 38.5' 33.3' Medium Sand CAPEWIDE ENTERPRISES - REQUIRED ADDITIONAL DESIGN FLOW=440 GPD-416 GDP =24 GPD SM8 � �� SM4� I C 2.5Y6l6 READING# 2 READING# 6 \ ,' fix, LEACHING CORNER(4) 48.7' 45.7' LOCATED AT NUMBER OF BEDROOMS(ACTUAL) 4 DEPTH OF WATER= 8.5' DEPTH OF WATER= 8.32 / �� \ LEACHING CORNER(5) 40.7' 56.2' DESIGN FLOW 110 GAUDAY/BEDROOM 707 SOUTH MAIN STREET j ELEV WATER= 2.8' ELEV WATER= 2.98' �i TOTAL DESIGN FLOW 440 GAUDAY DATE _ 2-20-08 @ 11:15 A.M. DATE _ 2-20-08 @ IM P.M. SM 5 a ?� / LEACHING CORNER(6) 27.8' 46.7' CENTERVILLE, MA 02632 GAUDAY DESIGN FLOW X 200 % 880 „ READING# 3 READING# 7 r o CENTERVILLE USE EXISTING 1000 GALLON SEPTIC TANK 104 -0.66' 2007 DEPTH OF WATER= 8.5' DEPTH OF WATER= 8.35' n w ELEV WATER= 2.8' _ r o RIVER g AL INCH - 20 FT. DATE: DECEMBER 27 FEET � °'- * See monitoring well data on plan- 0 10 20 ao so FEET ELEV WATER- 2.95 INSTALL 1 QUICK 4 STANDARD IINFILTRATOR DATE = 2-20-08 @ 11:30 A.M. DATE = 2-20-08 @ 1:30 P.M. ? z (TIDAL) RESERVED FOR BOARD OF HEALTH USE �,� ----- ------- "*NOTE: SYSTEM CAPACITY ��� PREPARED BY: READING# 4 READING# 8 EFFECTIVE LEACHING AREA OF 6.96 SF/LF OBTAINED FROM THE (TOTAL L.F. INFILTRATOR)(4.73 SF/LF)(0.74 GPD/SQ.FT.)= GPD JOHN L. �� JC ENGINEERING, INC. o CHURCH ILL DEPTH OF WATER= 8.45' DEPTH OF WATER= 8.35' 63 "MODIFIED CERTIFICATION FOR GENERAL USE" FOR INFILTRATOR (6.2')(""6.96 SF/LF)(0.74 GAL/SQ.FT.)= 31.9 GAL. LEACHING/DAY JR.L `° 2854 CRANBERRY HIGHWAY ELEV WATER= 2.85' ELEV WATER= 2.95' SYSTEMS ISSUED FEBRUARY 21, 2003(LAST REVISION TOTALS: EAST WAREHAM MA 02538 DATE = 2-20-08 @ 11:45 A.M. DATE = 2-20-08 @ 1:45 P.M. T JULY 19, 2007) BY THE COMMONWEALTH OF e _ _.__ _._. SITE E PLAN MASSACHUSSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL TOTAL LEACHING AREA: 508.273.0377 43.1 SQ.FT. � -- --- ! ------._ Note: Design based on EL.3.00'as previously used on design plan by JC Engineering,Inc.dated December 27,2007. AFFAIRS, DEPARTMENT OF ENVIRONMENTAL PROTECTION. TOTAL LEACHING CAPACITY: Drawn By: BSM Designed By:MCP { Checked By:JLC JOB No.1347 SCALE: 1' =20' 31.9 GAL./DAY f