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Home My WebLink About0035 STAGE COACH ROAD - Health 35 Stage Coach Road Centerville A= 173 - 047 ; ' r 17 a IJ10as a UPC 12534 .2.153E �aaw ' D C , C`C 0 ,Nf Commonwealth of Massachusetts /-73"0'7T Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Stage Coach Rd Property Address Blackwell Owner information is Owner's Name required for every Centerville MA 02632 9/28/17 page. Clty/Town State Zi Code P Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, SI IU 47 use only the tab 1. Inspector: l key to move your cursor-do not Chad Hathaway use the return key. Name of Inspector H.P.S. �I Company Name P.O.Box 151 ��I Company Address Forestdale Ma city/Town 02644 State Zlp Code 774-274-2581 Telephone Number 12866License 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 Inspector's S' ature Date 7 Date The system inspector sh sub ' a copy of this inspection report to the Approving Authority(Board of Health or DEP)within vs of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-page 1 of 17 r � Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M �l 35 Stage Coach Rd Property Address Blackwell Owner Name information is owner's required for every Centerville page. City/rown MA 02632 9/28/17 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: Septic in working condition B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Stage Coach Rd Property Address Blackwell Owner Owner's Name information is required for every Centerville page. Cityrrown MA 02632 9/28/17 State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if Pumps/alarms are repaired. B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed Pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): El broken pipe(s)are replaced [] Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. I. 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 safety and the environment: public health, ❑ Cesspool or privy is within 50 feet of a surface water El or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Stage Coach Rd Property Address Blackwell Owner Name information is Owner's required for every Centerville MA 02632 page. CitylIown 9/28/17 State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well*". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A c be attached to this form. gg opy of the analysis must 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 %day flow t5ins,3/13 Title 5 Official lnspeciion Form:subsurface Sewage Disposal System•Page 4 of 17 t ond\ Commonwealth of Massachusetts Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for VoluntaryAssessments essments `t 35 Stage Coach Rd Property Address Blackwell Owner Owner's Name information is required for every Centerville MA 02632 9/28/17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 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 any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspeclion Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 35 Stage Coach Rd Property Address Blackwell Owner information is Owner's Name required for every Centerville page. Cityll own MA 02632 9/28/17 C. Checklist State Zip Code Date of inspection Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ 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)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts ^ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments •`re 35 Stage Coach Rd Property Address Blackwell Owner s Name information is Owner' required for every Centerville MA 02632 page. City/Town 9/28/17 State Zip Code Date of inspection D. System Information Description: Number of current residents: 4 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspecpon Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments '( 35 Stage Coach Rd Property Address Owner Blackwell information is Owner's Name required for every Centerville MA 02632 page. Clio I own 9/28/17 State Zip Coe Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: none 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/Altemative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins•W13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments g 35 Stage Coach Rd Property Address Owner Blackwell 's information is Owner Name required for every Centerville MA 02632 page. %,t y/I own 9/28/17 State Zip Code Date of inspection D. System Information (coat.) Approximate age of all components, date installed(if known)and source of information: Tank and field 1978 Dbox replace 2015 per as builts on record at town hall Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1' feet Material of construction: { ❑cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: 20+ feet Comments(on condition of joints, venting, evidence of leakage, etc.): no signs of leaks or in ro er venting Septic Tank(locate on site plan): Depth below grade: 6" feet Material of construction: ®concrete El metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: year; Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 4## t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r� 35 Stage Coach Rd Property Address Blackwell Owner Owner's Name information is required for every Centerville MA page. Citylrown 02632 9/28/17 State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 3" Distance from top of scum to top of outlet tee or baffle 4" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? tape and sludge judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): pump every 2-3 years as maint. to protect leaching Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass 9 ❑polyethylene El other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments lug 35 Stage Coach Rd Property Address Blackwell Owner information is Owner's Name required for every Centerville page. CRY/I own Sae 02632 Zip Code Date of Inspection 9/28/17 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.): tees in place tank appears to be solid with no visable cracks or leaks. recommend pumping septic tank in 1 year under normal usage. recommend pumping of septic tanks every 2-3 years a maintenance t o protect leaching area Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑ metal ❑fiberglass ❑Polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 35 Stage Coach Rd Property Address Blackwell Owner Name information is Owners required for every Centerville MA 02632 page. Civi I own 9/28/17 State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): in good condition replaced in 2015 . It's a D65 no carry overs no signs of backing up or overloading Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): "If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection For Subsurface Sewage Disposal System Form-Not for Voluntaryh Assessments 35 Stage Coach Rd Property Address Blackwell Owner information is Owners Name required for every Centerville page. CitylI own M e 02632 Zip Code Date of inspection 9/28/17 D. System Information (cont.) Type: } ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1)18'x 28' ❑ 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.): Post hole du a hole into leaching field stone was clean and dry. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not fo r Voluntary Assessments M ' 35 Stage Coach Rd t'roparty Address Blackwell Owner Owner's Name information is required for every Centerville page. Citylrown MA 02632 9/28/17 State Da of D. System Information (cont.) Zip Code te Inspection Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•page 14 of 17 Commonwealth of Massachusetts UTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 35 Stage Coach Rd Property Address Blackwell Owner s Name information is Owner' required for every Centerville MA 02632 9/28/17 page. Cit f own State Date Zip Code of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties where public water supply enters the building. Check one of the boxes below:at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate to ® hand-sketch in the area below ❑ drawing attached separately Ik- F0 Gt C�.e f,S Cc�c,tr� I LI a S 6 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments t 35 Stage Coach Rd Property Address Blackwell Owner Owner's Name information is required for every Centerville MA 02632 page. Owl own 9/28/17 D. System State Zip Code Date of Inspection Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water. 7' feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: town GIS ma in You must describe how you established the high ground water elevation: town gis mapping contours shows backyard contours el. 56.73 near b leach field 2'6" below rade y y pond level 49.62. bottom of Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 ' Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments e 35 Stage Coach Rd Property Address Blackwell Owner s Name information is Owner' required for every Centerville MA 02632 9/28/17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 ve Town of Barnstable Barnstable Regulatory Services Department AMnWnCft sARNSTABIE, ,0� Public Health Division a�t 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 7597 August 26 2015 Jason & Melissa Blackwell 35 Stage Coach Road Centerville, MA 02632 A voluntary assessment was conducted on May 22, 2015 by Patrick Sullivan, a Certified Title 5 System Inspector, for the State of Massachusetts, on the septic system located at 35 Stage Coach Road, Centerville, MA The evaluation of the leaching facility showed that it is not functioning properly under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS consists of three perforated PVC 4" lines in an 18' W X 23' L X 6" D stone bed. Camera used to inspect all lines. Center line: heavy debris and soil first 7'; clear for next approx. 14'; line narrows in diameter with heavy debris, could not get camera to end of line. Interior line (closest to house): Could not get past second 90 degree turn in line due to heavy soils and debris in line. Outside line: could not get further than 2' past 90 degree turn due to heavy soils and debris in line. The SAS needs to be replaced. • Septic Tank needs to be pumped You are hereby officially notified of these findings and it is strongly recommended that you have the septic tank pumped and the SAS repaired; or you have the option to having the system re-examined by a third.independent Septic Systems Inspector certified by the State of Massachusetts. Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\35 Stage Coach Rd Cent Ju12015.doc PER ORDER OF THE BOARD OF HEALTH McKean, R.S., CHO Agent of the Board of Health Cc: Kendall Ayers, CSMLP P O Box 427 Barnstable, MA 02630 Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\35 Stage Coach Rd Cent Ju12015.doc 8/25/2015 Parcel Detail jHlE Elli t_% OIL;;S SAM5YA41 1\ y Nthss, 6W Logged In As: Parcel ®et al) Tuesday, August 25 2015 Parcel Lookup Parcel Info Parcel ID 173-047 I Developer Lot LOT 9 Location 35 STAGE COACH ROAD Pri Frontage 120 ' Sec Road _ F .I Sec Frontage Village CENTERVILLE I Fire District.C-O-MM Town sewer exists at this address No Road Index 1524 Asbuilt Septic Scan: 173047_1 173047 2 Interactive Map t, x 173047_3 i4t � 1730474 - Owner InfoCo- owner HOWES, ROBERT&TAf� owner �aBLACKWELL, JASON Streetl 35 STAGE COACH ROAa Street2 city CENTERVILLE I state MA _ _ I zip 02632 I country Land Info Acres 10.34 M- ��!use Single Fam MDL-01 _ Zoning 'RC�J - - —'Nghbd r0105 � e Topography Level Road Payed utilities Public Water,Gas,SeptlC Location Construction Info Building i of 1 Year 1978 Roof Gable/Hi exl WoodShinple J Built Struct p Wall g Living r1152 J Roof{AS h/F GIs/Cm J nc None Area ._I Cover p p Type _ ._� Style Cape Cod _ wall Drywall Room�4 Bedrooms nt Model Residential Ior Rooms Hardwood Bath Floor 1 Full-0 Half Grade 'A�erage TYPe Hot Water Roams 6 Rooms rho Heat Found- Stories ,1.4� rI Fuel ,Oil ation Poured Conc. Gross ',2404 A re a Permit History Issue Date Purpose Permit# Amount Insp Date Comments 5/19/2015 New Windows 201502235 $0 6/30/2016 12:00:00 ROOF, AM WINDOWS http:/f ssq I2fi ntranet/propdata/Pareel Detail.aspl?ID=12059 1/3 I i Town of Barnstable anruvsrAB Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone I to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any "conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑.Leaching pit or cesspool with high liquid level, <12"below inlet (per Town Code §360-9.1) OTHER Repair deadline: Y' Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Town of Barnstable Barnstable AWARMWaCft Regulatory Services Department- � ' Public Health Division Ml�A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4961 July 29, 2015 Dennis Kerkado %North Atlantic Realty Group 16 Kings Way Hyannis, MA 02601 A voluntary assessment was conducted on May 22, 2015 by Patrick Sullivan, a Certified Title 5 System Inspector, for the State of Massachusetts, on the septic system located at 35 Stage Coach Road, Centerville, MA The evaluation of the leaching facility showed that it is not functioning properly under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS consists of three perforated PVC 4" lines in an 18' W X 23' L X 6" D stone bed. Camera used to inspect all lines. Center line: heavy debris and soil first 7'; clear for next approx. 14'; line narrows in diameter with heavy debris, could not get camera to end of line. Interior line (closest to house): Could not get past second 90 degree turn in line due to heavy soils and debris in line. Outside line: could not get further than 2' past 90 degree turn due to heavy soils and debris in line. The SAS needs to be replaced. • Septic Tank needs to be pumped You are hereby officially notified of these findings and it is strongly recommended that you have the septic tank pumped and the SAS repaired-, or you have the Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\35 Stage Coach Rd Cent Ju12015.doc option to having the system re-examined by a third independent Septic Systems Inspector certified by the State of Massachusetts. PER ORDER OF THE BOARD OF HEALTH QTh cKean, R.S., CHO Agent of the Board of Health Cc: Kendall Ayers, CSMLP P O Box 427 Barnstable, MA 02630 f Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\35 Stage Coach Rd Cent Jul20l5.doc I _ i I , SENDER: • •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the card to you. B. Received by(Panted Name) C. Date of Delivery � ■ Attach this card to the back of the maiipiece, i or on the front if space permits. 1. Article Addressed to: D. Is delivery address different from item J ❑ If YES,enter delivery address below:': ap No•; Dennis Kerkado %North Atlantic Realty Group l 0 16 Kings Way 4 3. Service Type Hyannis, MA .02601 ❑Certified Mail® ❑Priority Mail Express' ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery.. . * 4. Restricted Delivery?(Extra Fee) ❑Yes 12. Article Number i (rransfer from service labeo 7 014 1200 0 0 01 0 3 5 8 -=4 9 61 rY�C , PS Form 3811,July 2013 o Receipt J Domestic Return Rec Jyp tl � tt '111fft III lltli;.ltft1a(it fillli:irt'l111111t1111111l#t+ltt c_e_ ` ;,_'• ' :. ` _ l:qt ' g L09Z0 `dW `SIuueAH y AeM S6ui}j 9 L \ dnoaD Ajjea�j 011ue11V ulaoN% ,�d,� �„ a opeNJaN Siuuaa • �� ss°h Q � e�d iJ d s , f T96h 9SE0 T000 002T bTOL i 560Z 6Z l�flf�-Zb£8£6000 5£L MI (/ 109Z0 diZ •� i09ZOt/W`s�uue,CH '900 0<�bW931>� _ Zo, I aaai;S u!sW OOZ SStlN a0[1Su.IiE2d �1'No1 Miioa�lq g 3o uA10,L 3 S3MO8 A3N1td 3!DV Od-S n 4' . r. F.� .-,y;,A; �.: ., .. .� „`r. .��..� s �, <, ,�� --� _ _ �' ,. �% ,\\ �'� __ __-- _�=_�-� -- f�_ , , THE Tp� Town of Barnstable Barnstable Board of Health I r ► MRNSfABLE ►' MAC. g 200 Main Street, Hyannis MA 02601 _ _ _ _ 2007 rfD MA'S a Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. 74 Junichi Sawayanagi July 15, 2015 Ms. Laura L.L. Peterson, Vice President Cape Cod Aggregates 1550 Phinney's Lane P.O. Box 517 Barnstable, MA02630 RE: Extension of Time to Repair or Replace Septic System 1660 Phinney's Lane Barnstable, MA Dear Ms. Peterson, At the July 7, 2015 meeting of the Board of Health, granted you on behalf of Cape Cod Aggregates, a two year extension until-July 15, 2017, to repair or replace the septic system at 1660 Phinney's Lane, Barnstable. You stated the dwelling is presently vacant and the water is turned-off. You indicated that you will need additional time to determine its future use. In the meantime, the home will remain vacant. The Board has no objections to your request for an extension with the understanding that the home will not be occupied and the water service remains turned-off. Please submit official documentation from the Water Department or from a licensed plumber indicating the water is turned-off. Sinc ely yours, ayne `iller, M.D. hainnAn Board of Health Q:\WPFILES\LorussoCapeCOd AggregatesExtension2015.doc 1W Town of Barnstable Barnstable s�uvsn►st.e, Regulatory Services De artment� � � I 1639. Public Health Division A1� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7014 1200 0001 0358 4961 July 29, 2015 Dennis Kerkado %North Atlantic Realty Group, 16 Kings Way Hyannis, MA 02601 • A voluntary assessment was conducted on May 22, Y 2015 b. Patrick Sullivan a Certified Title 5 System Inspector, for the State of Massachusetts, on the septic system located at 35 Stage Coach Road, Centerville, MA The evaluation of the leaching facility showed that it is not functioning properly under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • SAS consists of three perforated PVC 4" lines in an 18' W X 23' L X 6" D stone bed. Camera used to inspect all lines. Center line: heavy debris and soil first 7'; clear for next approx. 14'; line narrows in diameter with heavy debris, could not get camera to end of line. Interior line (closest to house): Could not get past second 90 degree turn in line due to heavy soils and debris in line. Outside line: could not get further than 2' past 90 degree turn due to heavy soils and debris in line. The SAS needs. to be replaced. .• Septic Tank needs to be pumped You are hereby officially notified of these findings and it is strongly recommended • that you have the septic tank pumped and the SAS repaired, or you have the Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\35 Stage Coach Rd Cent Ju12015.doc • option to having the system re-examined by a third independent Septic Systems Inspector certified b Y the State of Massachusetts. p PER ORDER OF THE BOARD OF HEALTH CTh7oklcKean., R.S., CHO Agent of the Board of Health Cc: Kendall Ayers, CSMLO P O Box 427 Barnstable, MA 02630 • I QASEPTIC\Letters Septic Inspection Failures or Future Evll35 Stage Coach Rd Cent Ju12015.doc Town of Barnst Barnstable Regulatory Services Department V P 3AIRNSTABLB, MAW 639.A� Public Health Division � 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0116 September 8, 2014 Robert& Tanya Howes 98 Seymour Street Warren RI 02885-3807 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 35 Stage Coach Road, Centerville, MA was last inspected on 8/4/2014 by John Graci a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The septic system tank needs a new outlet and distribution box needs to be replaced. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action PER ORDER OF THE BO OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\35 Stage Coach Rd Cent 2014.doc rq ,. r-q 0 .o - OFFICIAL USE Ul M Postage $ M r a Certified Fee P ��1$ rk Return Receipt Receipt Fee E Here C3 (Endorsement Required) Restricted Delivery Fee f `pa9 (ON(Endorsement Required) J C3 MTotal Postage&Fees o Robert & Tanya Howes 98 Seymour Street Warren RI 02885-3807 Certified Mail Provides: a A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For; valuables,please consider Insured or Registered Mail. a For an additional fee,a Return Receipt may be requested to provide proof of, delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the. fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate'return receipt,a LISPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or. addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted_ elivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail v receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt and present it when making an inquiry. ,, PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047 • • • COMPLE I TE THIS SECTION • • ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. [IAgent W, Print your name and address on the reverse X ❑Addressee so that we can return the card_to you. B. Received by(Punted Name) C. Date of Delivery E Attach this card to the back of the mailpiece, 1 or on the front if space permits. 1 1. Article Addressed to: D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑No l R6b,6 t & Tanya Howes 98 ',,eymour Street I Warren RI 02885-3807 3. Service Type ❑Certified Mail® ❑Priority Mail Express' � ❑Registered ❑Return Receipt for Merchandise ❑Insured Mail ❑Collect on Delivery I 4. Restricted Delivery?(Extra Fee) ❑Yes 2..Article Number — ----^ _ (Transfer from serv/ce labeq L 7 014 1200 0001 0358 0116 PS Form 3811-July.2013 Domestic Return Receipt t 11'4'i1�STxtttTit.t l ,i111"I'dI1t j13:1.pi'I'l1pI111111111111 111 T�� 666 '.. •• Z 9 b. -f PA 0!D 7'C 19 i�'A A v tl- '`S R. � •r-• C.Vdam.{�epe6yt,,{gUp4�pVgp'':y�,,i'. p� Vry4 {�V)Vpli V a'>r t V_ •.d.B 11 e - --a.41 -trl3:Y � _ INJ L08£-588ZO 121 uaaaeAA jeoijS anowA9S 86 Af �g }�aqo�/)1� SGMOH eAuel � VON & a1�j10& vt p d 1 � S 9TTO 9SE0 Z000 002T fir[U. 171•0Z '60 d3S4Zb£8£L000 0� v 109ZO VW`SruuBXH 8jF.900 $ All ZZ y SSdW 0 109Z0 dIZ ;aai1S u?RW OOZ . •3,adu�dd-a . aorsT suaet�all nd o uM SWOB UNlld<<3Jb'1SOd-s-n F � �+ a y s*�� • ^�Pr .. a r� �� r"' a ` i v a �" ��.,,. ��.� �—�" __, - '� _ -S,, � Town of Barnst Barnstable Regulatory Services Department A + 3ARNSTABM KASM � Public Health-Division i639 ,� m 200 Main Street, Hyannis MA 02601 2007 Office: 509-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7014 1200 0001 0358 0116 September 8, 2014 Robert & Tanya Howes 98 Seymour Street Warren RI 02885-3807 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 35 Stage Coach Road, Centerville,MA was last inspected on 8/4/2014 by John Graci a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • The septic system tank needs a new outlet and distribution box needs to be replaced. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action i PER ORDER OF THE BO OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health i Q:\SEPTIC\Conditionally Passes Ltr\35 Stage Coach Rd Cent 2014.doc � 1 v YJ http://issgl2/intranet/propdatalParcelDetail.aspx?ID=12059 Application Center(2) ®http--www.town.barnstable.., ®Application Center ®Suggested Sites Web`dice Gallery jFavorites i®Parcel Detail ir— - P c5le 16,74. ,pit Logged Parcel Detail 2014 Parcel Looku ' Y T Parcel Info -- - - if ii Parcel 173 0l7 ( Developer LOT 9 ?' I ID Lot Location 135 STAGE COACH ROAD ' Frontag9e 120 Sec ' Sec Road Frontage Village CENTERVILLE ' Fire C_O_MM District , Town sewer exists at this I . address No I Road Index 1524 '}\` Asbullt Septic Scan: Interactive 173047 1 Map Oviner Info i . Owner FHOUVES,ROBERT&TANYA I Co-Owner I ! Streets 135 STAGE COACH RD I Street2 f i City CENTERVILLE I State NIA Zip 02632 Country= t F , � Landlnfo � �' _J - - - - --_-- ---ZzZ�1�1 �I ''I_IiI Local intranet _ 3� ,j Et{100 (D O T 11 27 AM Parcel Detail Wind owsI Navigation CanceledWi..I Tuesday�� ff, � rZ1Y `� Postal (DomesticCERTIFIED MAILT. RECEIPT ti ru For delivery I our .me Ln cc Postage $ A N N � 1S ru Certified Fee L7 /,� Post rk p Retum.Receipt Fee "(!� Her O 0 (Endorsement Required) J estricted Delivery Fee (Endorsement Required) �I C3 R A d C3 q/ 0 ,Total Postage&Fees $ r / S ruj a Robert & Tanya Howes 35 Stage Coach Road Centerville, MA 02632 Certified Mail Provides: ■ A mailing receipt ■ A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. ■ Certified Mail is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For. valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of 1 delivery.To obtain Return Receipt service,please complete and attach a Return' Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail j receipt is not needed,detach and affix label with postage and mail. IMPORTANT.Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 �oF�He ro\ Town ®f Barnstable Barnstable ��°' `', Regulatory Services Department ,edcac , �{*y QARNS'I'ABLE, 90�"Ass. Public Health Division `i6gq.� w Tf0 MAt IV 200 Main Street,Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 4228 August 21, 2014 Robert & Tanya Howes 35 Stage Coach Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 35 Stage Coach Road, Centerville, MA was last inspected on 8/4/2014 by John Graci a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Conditionally Passed" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: The septic system tank needs a new outlet and distribution box needs to be replaced. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. You are ordered to repair or replace the septic system within sixty (60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action PER ORDER OF THE BOARD OF HEALTH TY r ias McKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Conditionally Passes Ltr\35 Stage Coach Rd Cent 2014.doc Commonwealth of Massachusetts -- = Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information n I on the computer, �1 !a(✓�� use only the tab 1. Inspector: 'vJ key to move your cursor-do not JOHN GRACI use the return Name of Inspector key. GRACI SEPTIC INSPECTIONS, LLC ,Q Company Name PO BOX 2119 Company Address r TEATICKET MA 02536 City/Town State Zip Code 508-641-6694 S 1468 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 syst ❑ Passes ® Conditionally Passes ❑ Fails ❑ Needs Further Evalu i by the Local Approving Authority • 08/04/2014 Inspector's Signature Date The system inspector s all 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. e'l t5ins•3113 Title 5 Official Inr�,.nl.r,. bsurface Sewage Disposal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. CityrTown 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: NA B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): NA t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts - - Title 5 Official Inspection Form - - Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑C 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 SEPTIC TANK NEEDS A NEW OUTLET TEE. DISTRIBUTION BOX IS DETERIOTATED AND NEEDS TO BE REPLACED. ❑ 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): NA C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ^M 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 - - page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: NA *' This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: NA 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 15ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts - ----_W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 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 any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 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)] 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 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts --� Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .0 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 GALLON SEPTIC TANK( NEEDS OUTLET TEE) , DISTRIBUTION BOX( NEEDS TO BE REPLACED)AND 18'X 28' X 6 LEACHING FIELD Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d TOWN 9 ( Y 9 (gp ))� Detail: 2011-19,000 2012- 56,000 2013- ZERO LESS THAN 1000 Sump pump? ❑ Yes ® t o Last date of occupancy: VACANT Date Commercial/Industrial Flow Conditions: Type of Establishment: NA Design flow(based on 310 CMR 15.203): NA _ Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): NA 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: NA t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts -- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): NA General Information Pumping Records: Source of information: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: NA gallons How was quantity pumped determined? NA Reason for pumping: NA Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts _ W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M - 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1978 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: (10)TEN INCHES feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): 20 PVC Distance from private water supply well or suction line: GREATER THAN 10+' feet Comments (on condition of joints, venting, evidence of leakage, etc.): NO COMMENT Septic Tank (locate on site plan): Depth below grade: (6) SIX INCHES feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: NA years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLON Sludge depth: (3)THREE INCHES t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface sewage Disposal system Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle (31)THIRTY ONE INCHES Scum thickness (8) EIGHT INCHES Distance from top of scum to top of outlet tee or baffle (6) SIX INCHES Distance from bottom of scum to bottom of outlet tee or baffle 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.): SEPTIC TANK APPEARS TO BE STRUCTURALLY SOUND NEW OUTLET TEE NEEDS TO BE PLACED TO FUNTION PROPERLY. RECOMMED PUMPING EVERY TWO YEARS UNBALE TO INSPECT UNDER NORMAL USEAGE. Grease Trap(locate on site plan): Depth below grade: NA feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Scum thickness NA 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 Date of last pumping: NA Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts w `title 5 Official Inspection Form -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD _ Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 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.): NA Tight or Holding Tank (tank must be pumped at time of inspection) (locate on site plan): Depth below grade: NA Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): NA Dimensions: NA Capacity: NA gallons Design Flow: NA gallons per day Alarm present: ❑ Yes ❑ No Alarm level: NA Alarm in working order: ❑ Yes ❑ No Date of last pumping: NA Date Comments (condition of alarm and float switches, etc.): NA Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts --- v `title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX NEEDS TO BE REPLACED AT TIME OF INSPECTION DISTRIBUTION BOX WAS DETERIORATED. Pump Clamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): NA * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: NA t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts _- W Title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 18'X28'X6" ❑ 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.): VIDEO INSPECTED ALL LINES WERE CLEAN AT TIME OF INSPECTION. APPEARS TO BE FUNCTIONING PROPERLY AND STRUCTUARLLY SOUND. UNBALE TO INSPECT UNDER NORMAL USAGE. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration NA Depth —top of liquid to inlet invert NA NA Depth of solids layer Depth of scum layer NA Dimensions of cesspool NA Materials of construction NA Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts w `title 5 official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M- , 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): NA Privy (locate on site plan): Materials of construction: NA Dimensions NA Depth of solids NA Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 • Commonwealth of Massachusetts -- - w Title 5 official Inspection Fora Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: Ej hand-sketch in the area below ❑ drawing attached separately BAC4 A t000 Gallon SeFAC B - G AA• 21 A lg'X 28'X b" Leaeh►ne� `�►eld A B 25� �1 AC 33 jO BA 20 913 Zq t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts -- w Title 5 official Inspection Form -- Subsurface Sewage Disposal System Form - Not for Voluntary Assessments \� 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 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: GREATER THE 10 FEET feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ; ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: AUGER Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 • Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 35 STAGE COACH ROAD Property Address Owner Owner's Name information is required for every CENTERVILLE MA 02632 08/04/2014 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 C;k' 1 TOWN OF BARNSTABLE .LOCATION �S s//�'JC Crgctj Poi. SEWAGE# �015® �o y VILLAGE C r,fCv01c ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY C?0,5X O!!I /G�y�ti//G,rti LEACHING FACILITY:(type) V e v F"C f d (size) NO.OF BEDROOMS OWNER PERMIT DATE: fS COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility f� Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) A,� Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY Q-jjox&&a..,1 G" � �a = asL a 9 � � _ 3 =31 No. /'� l S' O" 1 Fee ?60 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es ftplitatlon for 33ispozal 6pstem Construction i3ermit Application for a Permit to Construct( ) Repair�Upgrade( ) Abandon( ) [:]Complete System ❑Individual Components Location Address or Lot No. s'.49e.&ti tod Owner's Name,Address,and Tel.No. Sm' _I�G�i`&P Assessor's Map/Parcel A/p �, tb'/n&k f e" Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel. o. kl e,, L oin A CGvd d ep, '✓14 Type of Building: Dwelling No.of Bedrooms je /V L��Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) ` gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) 910 Md ow itd --c e Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date , /ail<� Application Approved by Date l 0 Application Disapproved by Date for the following reasons Permit No. n r (� Date Issued 3 -36 /' Fee UU � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye_�_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 01pplitation for Misoaal 6pstem'Construttion Permit Application for a Permit to Construct( ) Repair�Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �5 ��t�9e (� � Owner's Name,�Agddress,and Tel.No. sd�_nG'�itIIOD 0 f Assessor's Map/Parcel 3 -O y /VO✓�� IY O I(;' f e"A Installerr''s Name,Address,and Tel.INo. Designer's Name,Address,and Tel. o. I 14 Type of Building: I/� Dwelling No.of Bedrooms ��/�I Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures ti Design Flow(min.required) ) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description-of Soil Nature of Repairs or Alterations(Answer when applicable) r �r�llr D� (3/,1( anc� Du&4 T-C c: Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described'on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of ; Compliance has been issued by this Board of Health. Signed Date Application Approved by 0r Date7 J G Application Disapproved by Date for the following reasons Permit No. U Date Issued 3 3&Z/ ,. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned( )by ' II t at 3 r 1-c v GL `- has been constructed in accordance with the provisions of itle 5 and the for Disposal System Construction Permit No. �U 06, dated _7 �0 / r Installer Designer ' #bedrooms ✓v A— Approved design flow gpd � r The issuance of this permit shall not be construed as a guarantee that the system will function as designed. Date _? — I rj Inspector ""A—P 9, — 1 ' ----------------------------------------------------------------------------------------- --------------------------------------------- No. ;4 -U q Fee BUG THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair( Upgrade( ) Abandon( ) y 3 S �� 1. System located at o Co i� i o and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction m t be completed within three years of the date of this permit. Date ? G 7/i Approved by JUN-08-2010 03:23 BARN CDUNTY CSMP 5083756854 P.01i01 Reo' dvRooterExcavatinir May 26, 2015 'S l 9"6 Re: Voluntary Assessment of Septic System 35 Stage Coach Road c�m� Centerville, MA 02632 -0 k� 62c-� To Whom It May Concern: On May 22, 2015 I, Patrick Sullivan of Ready Rooter Excavating, Forestdale MA performed a voluntary assessment of the Septic System at 35 Stage Coach Road, Centerville, MA. The following are my findings: Septic tank: 1000 gallon precast tank 5" below grade. Tank appears to be structurally sound. Tank was recently pumped down for new outlet tee installation. Solids level in tank (both sludge and scum combined) is approximately 3' thick occupying 75% of tank capacity at the time of assessment. Recommendatioir. Tank needs to be pumped, cleaned and all solids removed before system is put back in use. D-Box: H-20 d-box was replaced March 2015 per permit on file at Board of Health. D-box is level with one inlet and three outlets. Speed levelers in place on outlet lines. Recommendations D-box is in good working order. Soil Absorption System: SAS consists of three perforated PVC 4" lines in a 18W X 251 X 6"D stone bed. Camera used to inspect all lines. Center line: heavy debris and soil first 7'; clear,'for next approx. 14'; line narrows in diameter with heavy debris, could not get camera to end of line. Interior line (closest to house): Could not get past second 90 degree turn in line due to heavy soils and debris in line. Outside line: could not get further than 2' past 90 degree turn due to heavy soils and debris in line. Recommendations Soil absorption system can no longer perform to original design flow. SAS needs to be replaced. 't Should you have any questions, please feel free to contact me at (508)-888-6055. Regards, ft tfickT Suffivan Patrick T. Sullivan Certified Title 5 System Inspector,SI12843 TOTAL P.01 LO C T ION SEWAGE PERMIT NO. CL VILLAGE INSTA LLER'S NAME S ADDRESS 7 Z CAdt TL1*c*?L £— B U t L D E R OR OWNER. CSAf'4'T-"' I L-L DATE PERMIT ISSUED DAT E CO-MPLIANCE ISSUED J/,;,�-7� -------------------------------- o us 1 � A �7! �s...........`..... r THE COMMONWEALTH OF MASSACHUSETTS `. BOAR® OF HEA 3,5...E liration for N 'vs al 18orkii Cn inotrurtiun Virmit }Application-is hereby.-made for a Permit to Construct ( ) or Repair (. ) -an Individual Sewage Disposal System at _ ��_ / Locatio 1 Addres •dr t No, :C-.,r!llj.�'.1�.: Lr.:�-:.._�.r�'.�� -��---•-`=='�-J�,IZ-l��dc�_---- •,c/�f�'�f.�`•!``''�- Owner Address E _ :�............................. � i . __% . _..... Installer Address Type of Building Size Lot_:,.�.�_ _Q :.Sq. feet aDwelling—No. of Bedrooms._____ 2. .............. __::___Expansion Attic ( ); Garbage Grinder (AIPT' p., Other Type of 'Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria Q' 1 1Other fixtures ............................................... -•-=-----•-- W Design' Flow_:__:........._,.____________________gallons per person per day. Total daily flow_._-_._ i ___._____._ gallons. WSeptic.Tank—Liquid capacity./P allons Length................ Width................ Diameter..................Depth_................. x Disposal Trench!—No_____________________ Width....Li�.......... Total Length______ ____ Total,leaching area---,Y11► _At.....sq. ft. Seepage Pit No..... . Diameter__ -_.:_ Depth-below inlet_ff`'f�" :___ Total leaching area...............:__sq. ft. Z Other Distribution box fX) Dosing tank ( ) ems`�� -- �` 7F> '~ Percolation -Test Results Performed by._____ .,d�l�__... !....................................... Date_.__.. ar Test Pit No. 1................minutes per inch Depth iof. Test Pit.................... Depth to ground water_._: ...... 0-4 -Test Pit'No. 2________________minutes per inch Depth.of.Test Pit.................... Depth to ground water-------.................. a a (" ��.....__.... x Descri ion Soil ___._Q_.�_y_ t.�,._ �� :._lam ---- �_ ---`_-=_,�_-!_ _ w - -; ` x --•-•---------------=-----------------------------------------------•------._._..----------•-•----• --------------------------•...-••------•--------•--•----•- U Nature of Repairs or Alterations-Answer when a:pplicable............................... -----•--•----------------•-------------••---------------------------------_------...---•---......----••----=-----------------------...---------------------------------------•---=--=---......_••---- Agreement: The undersigned;agrees to install-the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary.Code— The undersigned further agrees not to place the system in operation until a Certificate of.Compliance has bee issued by t board of health. ' Sign �` '' `�' �� `. St Date Application Approved By....... . .......Lv '___ ��a{ll .--. ....... Date d Date Application Disapproved for the following'reasons_........._.........................................................--------------•--.----'- --------------- ............................................ ...-----_...• --•....-•-•------•- -•-•-•. � ^—Date PermitNo..........................................................-. Issued... f .................. Date �_ a No..------ Fmc :7...................... THE COMMONWEALTH OF MASSACHUSETTS OF HEAL ... ......... ----------*---------- --------------------------- Appliration for Uhipoiial Works Tonotrurtion ramit Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal SYS17. ................................................... ...................................... ...................... Locati h Add o t N� W ............ ...... fFd 7'-------------- ....................... . .................................. Address............lo�e-,W... ---------------------......... ..................................... CQ Installer Address Type of Building Size .....Sq. feet U Dwelling—No. of Bedrooms._... ..............................Expansion t1tic ;Garbage Grinder Other—Type of Building ____________________________ No. of persons___.___....... ............Showers Cafeteria Otherfixtures .............................................................................. ..................... Design Flow................1%T ......................gallons per person per day. Total daily flow........ ............ .....................gallons. 1:4 Septic Tank— uid capacity/ Ions Length._.............. W,�4th................ Diameter DeDth................ Disposal Trench No. __......... Width ...... , _06.......... Total Length........2. Total leaching area.___V�.��.....sq. f t. Diameter d.*JnI I P11 F al;ea *g area..................sq. f t. Seepage Pit No..._""?' ""______. D .................. Depth Selii" is I e C� Z Other Distribution box-o<) Dosing to ,I ) V. to Xh r.44,: 14 *611 - Percolation Test Results "Performed by.....Y�&-6--------V1............................................ Date...../................... ;I ....... Test Pit No. 1................minutes per inch -Depth of Test Pit......................... Depth to ground water.... ............ 44 Test Pit No. 2..........t......minutes per inch Depth of Test Pit.................... Depth to ground water........................ 0 -------I'll--------- 7f2:;" ,2 Z' Decion g SoIo. .... ------ - ----- ----- ----------------- ..... ....... �� / .....................y. .... .!..... A.... w .. . . .. 7 T. 4 ----------------------------- ....*! P........t .. ........... -------------- ------ W -- ------------ ........................................................................................................................................................... U Nature of Repairs or Alterations—Answer when applicable------------------------------------------------------------------------------------------------ ........................................ ...77: w-----------------------......I---------------------------------------------------------------------7......................................... Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with P the provisions of T IT!L- 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until"a Certificate of Compliance has issued by tA board of liea4lL_ ----------- --- ---------------------------- .............. Sigp&4� ............ ......... -------------- Date Application Approved By.... ............ ..................... .... ....... floe Date Application Disapproved for the following reasons:................................................................................................................ ................................................................................................I....................................................................................................... Date PermitNo.......................................................... IssuedL................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF....................... ....... ........... ....wv...................... (9prfifiratr of Toutpliatta THUII.,.,,1 /0 C,RTeL.�. he Individual Sewage Disposal System constructed or Repaired 22nr............... ...ff.........n................................. Z.................. --------X. b, . .. ........ ------Alf at......... .......&------ ----------------------- has been installed in accordarig with the provisions of TIPA ��of The State Sanitary Code as described in the applicationfor Disposal Works Construction Permit No--------------Oq...................... dated---/--_?/- 7,+;�I . .................................... `1HE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE.THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE.. `. .......... ..... ................... Inspector...... ......... ......... . .......... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........OF............z .... .............;.................................. .2 No......................... FEE........................ Riiposal 19 rh o udion "amit Permission4�_hereby granted.................... ......... .... ........ ... ..................................... )ySt4a,/_ .............. ......7, ,e "4_pof.....- ----------- -- ------- 'a-------------------------- ............. to ConstructiC Rege-ir) an In Sewage S at No..... Street as shown on the application for Disposal Works Construction PergQ No = Dated------ ....... . ........................... Board of VVV DATE---------...........................n.......................................... FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS ,. 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