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0198 STRAWBERRY HILL ROAD - Health
1 )8 Strawber p ilhRoad Centerville A = e �llli �aFcvcc�o� UPC 10259 a No. H� 1630R '� NAYTINGS MN Y I . VV COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS I Y DEPARTMENT OF ENVIRONMENTAL PROTECTION h ',1 `veyeh David B.Mason,R.S,Certified Title V Inspector,508-833-2177 � U� TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 198 Strawberry Hill Road,Centerville,MA Owner's:Kamenelis 4 Owner's Address: Same o ate of Inspection: May 28,2008 � Name of Inspector: (please print)David B.Mason t m �'1 Company Name: N.A. N , Mailing Address: 4 Glacier Path —a East Sandwich,MA 02537 Telephone Number: 508-833-2177 "' W cr— CERTIFICATION STATEMENT •.i �'' 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: X Passes _Conditionally Passes _ Needs Further Evaluation by the Local Approving Au ority Fails Inspector's Signat Date: 0 The system inspector shall submit a copy his inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments: System as inspected is operational. Increase in occupancy may result in failure. Tank needs maintenance pumping.The information as identified represents only the condition of the system on May 28,2008 at 1:00 PM. ****Thus 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. Title 5 Inspection Form 6/15/2000 page 1 f T Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed COMPLETED) distribution box is leveled or replaced (THIS IS REQUIRED TO BE 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: OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles G TncnPrtinn Fnr 411 V1000 2 Page 3 of 11 PART A CERTIFICATION(continued) Property Address: 198 Strawberry Hill Road Owner:Kamenelis Date of Inspection: May 28,2008 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. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles S Tncnartinn Fnrm All';00 n 3 Page 4 of 11 PART A CERTIFICATION(continued) Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool _X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X Liquid depth in cesspool is less than 6"below invert or available volume is less than %z day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] NO_(Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Titles S Tncnartinn Fnrm F/1;i')n00 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant, or Board of Health _X Were any of the system components pumped out in the previous two weeks? _X Has the system received normal flows in the previous two week period? _X Have large volumes of water been introduced to the system recently or as part of this inspection? _X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X _ Was the facility or dwelling inspected for signs of sewage back up ? _X _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site. _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems '? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _X _ Existing information.For example,a plan at the Board of Health. _X_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles 5 Tnenartinn Fnrm 6/1 5/70M 5 r Page 6 of 11 PART C SYSTEM INFORMATION Property Address: 198 Strawberry Hill Road Owner:Kamenelis Date of Inspection: May 28,2008 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 (per assessors records)Number of bedrooms(actual): 3 septic design DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): (330 gpd capacity) Number of current residents:_4 Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system (yes or no): NO [if yes separate inspection required] Per owner Laundry system inspected(yes or no):NA Seasonal use: (yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2006:,33,000 gal. 2007 28,000 gal. Sump pump(yes or no):No Last date of occupancy: current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: System pumped moments after inspection due to the need for maintenance pumping. TYPE OF SYSTEM _X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system (yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: 5/17/02 Were sewage odors detected when arriving at the site(yes or no):no OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Titles S Tnenvrtinn Fnrm A/1 5/Ifl(Nl 6 Page 7 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road P tY Y Owner:Kamenelis Date of Inspection: May 28,2008 BUILDING SEWER(locate on site plan) Depth below grade: Approximate; 24 Inches Materials of construction:_cast iron _X_40 PVC_other(explain): Distance from private water supply well or suction line:_NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. SEPTIC TANK: N.A.(locate on site plan) Depth below grade: 18 inches Material of construction: X_concrete_metal_fiberglass_polyethylene_other(explain)_ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Typical 1500 gallon tank Sludge depth: 11" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness: 10 inches Distance from top of scum to top of outlet tee or baffle: 15" Distance from bottom of scum to bottom of outlet tee or baffle: 12.5" How were dimensions determined: Actual measurements with tape and scour stick. Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) PVC inlet tee in good condition,PVC outlet tee in good condition,Effluent level with outlet pipe. In need of Maintenance Pumping. No evident structural issues. GREASE TRAP: N.A. Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions:' Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Tit1P S Tnenartinn Pnrm 0;/1 Si')nnn 7 Page 8 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner:Kamenelis Date of Inspection: May 28,2008 TIGHT or HOLDING TANK:—N.A.—(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity. gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X_(if present must be opened)(locate on site plan) Depth of liquid level even with outlet invert: liquid level even with outlet pipe 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.): No Indication of solids carryover. Effluent is level with outlet invert.D-box 32 inches below grade. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Title G Tnenvrtinn Pr% m A/1 VM00 8 Page 9 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number _X_leaching chambers,number:4 infiltrators _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, etch Identified inspection port. Stone is clean no indication of effluent in chambers. No ponding 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 or no): Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): PRIVY:_N.A._(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil, signs of hydraulic failure,level of ponding, condition of vegetation,etc.): OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS Titles S Tnenartinn Fnrm All 1;0000 9 Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 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. W A Rear B DECK P-1 O ❑ F] 0 2 Al 24'-2" Inspection Port to Grade A2 28'-8" A3 24'-5" B 1 24'-7" 132 27'-2" 133 53'-1" OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM T1t1P S TnenPptinn Fnrm (,/1 C/')0(10 10 Page 11 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner: Kamenelis Date of Inspection: May 28,2008 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_15_feet Please indicate(check)all methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked, date of design plan reviewed: _X_Observed site(abutting property/observation hole within 150 feet of SAS) _X_Checked with local Board of Health-explain: Recent Test Holes, Existing engineer records with BOH _X_Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you i y established the lugb ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography. T41P r,TncnAe-f;nn Pnrm A/1 Vnnnn 11 Town of Barnstable OF 1HE 1p� Regulatory Services BARNSTABLE, " Thomas F. Geiler, Director `j�ArF1639.p3,�A Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 Office: 508-86274644 Fax: 508-790-6304 REGARDING SEPTIC INSPECTIONS BY PRIVATE CONTRACTORS DISCLAIMER 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 or copy of the report; this Division does not warranty the functionality of the septic system in the future nor does this Division agree with any technical observations 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 Works Construction.Permit". If you should have any questions regarding this report, please contact the certified Septic System Inspector who conducted the inspection. QASEPTIC\Disclaimer Private Septic Inspections.DOC " COMMONWEALTH OF MASSACHUSETTS D EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS = DzPARTMENT OF ENviRONMENTAL PROTECTION yes David B.Mason,R.S,Certified Title V Inspector,508-833-2177 TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 198 Strawberry Hill Road,Centerville,MA Owner's: Linde �y; Owner's Address: Same Date of Inspection:July 27,2005 c Name of Inspector:(please print)David B. _- Company Name: N.A. <t rto `r Mailing Address: 4 Glacier Path "' co East Sandwich,MA 02537 r, Telephone Number,508-833-2177 � 4 CERTIFICATION STATEMENT r Jca I certify that I have personally inspected the sewage disposal system at this address and that the in rmationl'repontQ 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: X Passes Conditionally Passes A Needs Further Evaluation by the Local Approving Auth rity Fails Inspector's ftna • . 0&4 Date: 7 Z� 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. Notes and Comments:System as inspected is operational. Increase in occupancy may result in failure. Tank needs maintenance pumping.The information as identified represents only the condition ofthe system on July 27,2005 at 12:00 PM, ****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. Pdge 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X, _ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 in or 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements.If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent.System will pass inspection ifthe existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box.System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced (THIS IS REQUIRED TO BE COMPLETED) 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS Page 3 of 1 l PART A CERTIFICATION(continued) Property Address: 198 Strawberry Dill Road Owner: Linde Date of Inspection:July 27,2005 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 T Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 4 of I 1 PART A CERTIFICATION(continued) Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for gll inspections: Yes No T _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X_ Discharge or pending of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool 4 X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than Yz day flow X_ Required pumping more than 4 tunes in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped X_ Any portion of the SAS,cesspool or privy is below high ground water elevation, X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surt?ace water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis most be attached to this form,] NO_(Yes/No)The system&LI I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no _ — the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ — the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X Were any of the system components pumped out in the previous two weeks? X_ Has the system received normal flows in the previous two week period? T _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? Xi — Were as built plans of the system obtained and examined?(If they were not available note as NIA) _X_ — Was the facility or dwelling inspected for signs of sewage back up? _X_ ___. Was the site inspected for signs of break out? _X Were all system components,excluding the SAS,located on site. _X— _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of Construction,dimensions,depth of liquid,depth of sludge and depth of scum? X_ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of Health. X_ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)) OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 6 of 11 PART C SYSTEM INFORMATION Property Address: 198 Strawberry Hill Road Owner: Linde Date of Inspection:July 27,2005 >Flow coxDrrloxs RESIDENTIAL Number of bedrooms(design): 3(ver assessors reco M Number of bedrooms(actual):3 septic design DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):(330 gpd capacity) Number of current residents:_4_ Does residence have a garbage grinder(yes or no):NO(Not Allowed) Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required]Per owner Laundry system inspected(yes or no):NA Seasonal use:(yes or no):NO Water meter readings,if available(last 2 years usage(gpd)): 2004:,105,000 gal. 2003;67,000 gal. Sump pump(yes or no):No Last date of occupancy:current COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): �pd Basis of design flow(seats/persons/sgft,etc,): Grease trap present(yes or no):,_,_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no):— Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Was system pumped as part of the inspection(yes or no): No If yes,volume pumped:_____gallons--How was quantity pumped determined? Reason for pumping: System pumped moments after inspection due to the need for maintenance pumping. TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system —_—Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) —Tight tank —Attach a copy of the DEP approval _Other(describe): Approximate age of all components,date installed(if known)and source of information:5/17/02 Were sewage odors detected when arriving at the site(yes or no):no OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM I Page 7 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Bill Road Owner:Linde Date of Inspection:July 27,2005 BUILDING SEWER(locate on site plan) Depth below grade:Approximate;24 Inches Materials of construction: cast iron X_40 PVC other(explain): Distance from private water supply well or suction line: NA Comments(on condition of joints,venting,evidence of leakage,etc.): Appears in good condition. No evident leakage. SEPTIC TANK:N.A.(locate on site plan) Depth below grade: 18 inches Material of construction:X_concrete metal_fiberglass____polyethylene_other(explain)_ If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: Typical 1500 gallon,tank Sludge depth: I I" Distance from top of sludge to bottom of outlet tee or baffle: 14" Scum thickness: 10 inches Distance from top of scum to top of outlet tee or baffle: 15" Distance from bottom of scum to bottom of outlet tee or baffle: 12.5" How were dimensions determined: Actual measurements with tape and scour stick. Condition of tank(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.) PVC inlet tee in good condition,PVC outlet tee in good condition,Effluent level with outlet pipe. In need of Maintenance Pumping. No evident structural issues. GREASE TRAP; N.A. Depth below grade:____ Material of construction:_concrete metal_ __ polyethylene polyethylene other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle:_ Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels as related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page 8 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 TIGHT or HOLDING TANK:_NA,(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain): Dimensions: Capacity: gallons Design Flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: X (if present must be opened)(locate on site plan) Depth of liquid Ievel even with outlet invert:liquid level even with outlet pipe 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.):No Indication of solids carryover. Effluent is level with outlet invert.D-box 32 inches below grade. PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS i Page 9 of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 SOIL ABSORPTION SYSTEM(SAS): X`(locate on site plan,excavation not required) If SAS not located explain why: Type _leaching pits,number T X_leaching chambers,number:4 infiltrators _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 pending,damp soil,condition of vegetation, etch Identified inspection port. Stone is clean no indication of effluent in chambers. No pending CESSPOOLS:T(cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of pending,condition of vegetation,etc.): PRIVY:—N.A.—(locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure,level of pending,condition of vegetation,etc.): 11 /\TT.'T riT J T T1TlO�fw1/^.RZA1T T/\111 f 1TL\'! 1n I�11 tT/�'t yT�T/� Tit !Y!`IT.'1(Yry1lT1TTY` Page 10 of 11 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner: Linde Date of Inspection:July 27,2005 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. J _ - - ) Kv I ►� 2 -2,1-2 OFFICIAL INSPECTION FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Page l l of 11 PART C SYSTEM INFORMATION(continued) Property Address: 198 Strawberry Hill Road Owner:Linde Date of Inspection:July 27,2005 SITE EXAM Slope Surface water Check cellar (crawl space) Shallow wells Estimated depth to ground water_15_feet Please indicate(check)all methods used to determine the high ground water elevation: X_Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain:Recent Test Holes, Existing engineer records with SOH Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Utilized existing site design information on file with the Board of Health. Additionally,existing site and abutting site topography. TOWN C?F•BARNSTABLE L�-')CATION 19 SEWAGE # VII.L)LGE �� 1�.�� u; �vr ASSESSOR'S MAP & LOT Zq7-/! INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY �D LEACHING FACILITY: (type) (size) NO.OF BEDROOMS BUILDER OR OWNER PERMTTDATE: 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 J--Okyl M• LIKA e 60 w;J n, i ° • -rc .,yam c ��• ��� � ... �� %L�a�- �� i�o�sc . , TOWN 0;� PA 4NSTA$LE �- =_0"71I0N l-Yg S�,,cw,6err. �/.�� /�� a SEWAGE # o?0002' 0l0 f.GE �. ASSESSOR'S MAP & LOT o?`/7— /A( INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY So® LEACHING FACILITY: (type) Ir�Y",111pg1orJ (size) f)( 3AX NO. OF BEDROOMS pp BUILDER OR OWNER lTo�►h L,�no�F PERMITDATE COMPLIANCE DATE: lak Z 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 / � � 'Alp, �Rn k �y�f 3 c Lr °2�. C �� ���4y T4nk OvT�Pt O 30/ i J 3.2 No. UU -U!U 3 ' FEE COMMONWEALTH OF MASSAC14USETTS fc 3. Board of Health,�Bcm, '�'L APPLICATION FOP, DISPOSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit to Construct( ) RepairXUpgrade( ) Abandon( ) - ❑Complete System XIndividual Components Location S ` Owner's Name N L Map/Parcel#M 1 , `'�� �� Address I-1(� I Lot# Lt,T *�g Telephone# Installer's Name �S,0— R1+0 Designer's Name Address Address T ` Telephone# Telephone# swe7cq MN Q Type of Building Q Lot Size Q ^sq.ft. Dwelling-No.of Bedroom Garbage grinder Other-Type of Building No.of persons Showers (4, afeteria (� Other Fixtures Design Flow (min.required) gpd Calculated design flow � 7rDesign flow provided 4�5�.SYgpd Plan: Date q, Number of sheets t Revision Date Title Description of Soil(s) Soil Evaluator Form No. Name of Soil Evalual SOM Date of Evaluation DESCRIPTION OF REPAIRS OR ALTERATIONS _ The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not place the system in operatio�unfil a Certificate of Compliance has been iss by a Board of Health. Signed Date 56N- [- //-a z r- I?- fl _ Inspections v No. DUB 'UIU ry�'t �:a '�� k' i~_ ,_.,.. `' �,,....�.� �' FEE .�(JV COMMONWEALTH Of MASSACHUSETTS r' ' ''Board of Health, ArNVKe , MA. DISPOSALAPPLICATION FOP, r Application for a Permit to Construct( Repair UpdadeO Abandon( - 0 Complete System XIndividual Components Location �,� Owner's Name :Tc"rA LI Map/Parcel# ' , 1� CtuiL-��j LL .Address �� P} i �cawb r v Lot# �- � Telephone# �•Installer's Narne I Q Designer's Name A`it ' U►fU0(1VA0,1 VCC Address Address � Z4 q TCv-1E---CS C` C rnCA Telephone# Telephone# KA 1: Q AS \ r Type of Building 0A Lot Size c- — sq.ft. Dwelling-No.of Bedroom ' . a Y,rnS Garbage grinder Oqh f •` Other-Type of.,B ilding ,-�C)�+�rp(� JCZ"wC O No.of persons Showers (VrCafeteria (✓j Other Fixtures Design Flow (min'.required) gpd Calculated design flow '}• 3VDesign flow provided gpd Plan: Date Number of sheets ' Revision Date Title Description of Soil(s) 1C,•Soil Evaluator Form No. �, C �� Name of Soil Evaluato ,.A 5"q Date of Evaluation t- 1 DESCRIPTION OF REPAIRS OR ALTERATIONS I , The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees to not place the system in operation until a Certificate of Compliance has been rssr by a Board of Health. Signed Date 2 Inspections a' t R:X_-'-ae-,�.� -,.-�.:¢._c,A.:-�.:. ,..;�:..a__ r�s-1.<.>%•::::S-- -._'__ ...__.-.- _._�-._�..a_..--�,_ .�.-_-..,. .,-...*--'_ _-. ..._.... ...-- _.-_t..- _ ..a_4.. �. z.e .�,..+e:-'- .:x No. 200, - a COMMONWEA T14 OF MASSAC i`�USETTS FEE Board of Health, V' V" S ie,61 (' , MA. CERTIFICATE OF C®MP][IANC� Description of Work: ❑Individual Component(s) 10Complete System The undersigned hereby certify that the Sewage Disposal System; Constructed ( ),Repaired ( ,Upgraded ( ),Abandoned ( by: h1f at rc- 1 l has been installed in accordance with the pr visions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to application No. 200)-Ult/ dated Approved Design Flow 3O(gpd) Installer S Ai Designer: Inspector: 41J Date: ' )Z s. The issuance of this permit shall not be construed as a guarantee that the system will function as designed. A, No. 0 FEE COMMONWEALTH Of MASSACHUJ$[TTS '14 Board of Health, Q ce r o, .C t,�< �' , MA: DISPOSAL SYSTEM['l[ CONSTRUCTION PERMIT Permission is hereby granted to; Construct( ) Repair�o Upgrade( ) Abandon( ) an individual sewage disposal system c , at q [J S? lro teJ <'I�r,^ti rr l /Q�' as described in the application for . Disposal System Construction Permit No. 2'0 U , dated lil b Z Provided: Construction shall be completed within three years of the date of this permit. All local conditions must be met. Form IIII Rev.1111 A.M.Sulkin U.Boston,MA Date Board of Health_�_(/�n 0�14._,�if i d TOWN.OF BARNSTABLE C LOCATION �� -s �� SEWAGE # c200C� 010 VILLAGE ASSESSOR'S MAP & LOT. o?`1T' f/lv INSTALLER'S DAME&PHONE N0. T 6 Ae SEPTIC TANK CAPACITY 50�, LEACHING FACILITY: (type) � '1�r�7�o�1 (size) yX 3a X aL NO. OF BEDROOMS 3 BUILDER OR OWNER , `^�e PERMIT DATE: COMPLIANCE DATE:—S�17. 01 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 A & � 1�O4r o�lta✓fe r TF;Z,0 n, 1ST°y Tk�k oar/Pr 3 0' o O o ti K p-/ja X a y " J-2 r . 3.2 ;} TOWN OF BARNSTABLE r LOCATION SEWAGE # VILLAGE h *�•►:�— - .�--,� ASSESSOR'S MAP&LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY i LEACHING FACILITY: (type) (size) NO.OF BEDROOMS ,3 BUILDER OR OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and 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 fac*lity) Feet Furnished by�6/✓• �/ ' ` (? r �'+�� � �6�+ . , �� ���� y I � � - �z., i 3 s' . . FORM 11 — SOIL EVALUATOR FOR .r Page 1 of No.: Date: 1/4/02 COMMONWEALTH OF MASSACHUSETTS Barnstable , Massachusetts Performed By: Carmen E. Shay Date: 1/04/02 Witnessed By: Waiver— Per Barnstable BOH Location Address or #198 Strawberry Hill Road, Owners Name: John Linde Centerville,MA Address: 198 Strawberry Hill Rd,Centerville Lot# Map 247 Lot 116 MA 02637 New Construction : Repair : X Telephone Number: 508-889-0446 OFFICE REVIEW: Published Soil Survey Available: No ❑ Yes ❑ Year Published: Publication Scale: Soil Map Unit: Drainage Class: Soil Limitations: Surficial Geologic Report Available: No❑ Yes❑ Year Published: Publication Scale: Geologic Material: (Map Unit): Landform: Glacial Outwash Flood Insurance Rate Map: Above 500 Year Flood Boundary: No ❑ Yes Within 500 Year Flood Boundary: No 57 Yes ❑ Within 100 Year Flood Boundary: No a Yes ❑ Wetland Area: None Observed National Wetland Inventory Map (map Unit): Wetlands Consercancy Program Map (map unit): Current Water Resource Conditions (USGS): Month Range: Above Normal ❑ Normal F-X ] Below Normal ❑ Other References Reviewed: USGS,Topographic Map DEP APPROVED FORM 12/7/95 r FORM 11 _ 'SOIL, EVALUATOR FORM Page 2 of 3 Location Address or Lot No.: #198 Strawberry Hill Road, Centerville, MA On -Site Review Deep Hole Number: #1 Date: 1/4/02 Time: 9:00 PM Weather: Sunny, Warm, 35OF Location (identify on site plan): Refer to Sketch Landform: Outwash Plane Position on Landscape (sketch on back): Refer to Sketch Distances From: Open Water Body N/A feet Drainage Way N/A feet Possible Wet Area N/A feet Property Line 25' feet Drinking Water Well N/A feet Other N/A feet DEEP OBSERVATION HOLE LOG Depth From Soil Soil Soil Soil Other Surface Horizon Texture Color Mottling Structure, Stones, (inches) (USDA) (Munsel) Boulders, Consistency, % Gravel 0" — 12" A Sandy 10 YR 3/2 None Friable Loam 12" — 32" BW Sandy 10 YR 5/6 None Friable Loam <5% Gravel 32" — 168" C1 Sand 2.5 Y 7/4 None Med-Coarse Sand, 5% gravel/cobbles, Loose Parent Material (Geologic): Glacial Outwash Depth to Bedrock: N/A Depth to Groundwater: Standing Water in the Hole: None Weeping From Face: N/A Estimated Seasonal High Water Table 168"Assumed DEP APPROVED FORM 12/7/95 FORM 11 - SOIL EVALUATOR FORM Page 3 of 3 Location Address or Lot No.: #198 Strawberry Hill Road, Centerville, MA Determination of Seasonal High Water Table Method Used: ❑ Depth observed standing in Observation Hole: inches ❑ Depth weeping from side of Observation Hole: 168" inches (assumed) ❑ Depth to Soil Mottles: inches ❑ Groundwater Adjustment: None feet Index Well Number: Reading Date: Index Well Level: Adjustment Factor: Adjusted Groundwater Level: N/A DEPTH OF NATURALLY OCCURING PERVIOUS MATERIAL: Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system: Yes CERTIFICATION: I Certify That on September 17, 2000, (date), I have passed the soil evaluators 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 CMR 15.017. Signature: Date: FORM 12 �- �PERC.OLATION TEST Location Address or Lot No.: #198 Strawberry Hill Road COMMONWEALTH OF MASSACHUSETTS Centerville , Massachusetts Percolation Test Date: 1/04/02 Time: 9:45 AM Observation Hole #: #1 #1 Depth of Perc 36" Start Pre-soak 9:45 End Pre-soak 9:51 Time at 12" Will Not Hold 24 Gallon Presoak Same Time at 9 Time at 6" Time (9-6") Rate Min./inch < 2MP1 Assumed @ 36 " Same * Minimum of 1 percolation test must be performed in both the primary area AND reserve area. Performed By: Carmen E. Shay Witnessed By: Waiver per BOH Comments: Would Not Hold 24 Gallon Presoak - <2 MPI Assumed (cD 36" Site Passed X Site Failed DEP APPROVED FORM 12/7/95 SKETCH OF PERC TEST & DEEP HOLE LOCATION Property Address: #198 Strawberry Hill Road Centerville,MA Owner: John Linde Date of Pere Test: 1/04/02 Test 15' Hole #1 40' Existing House Foundation 4 Bedrooms Strawberry Hill Road Sep-20-01 13: 52 BARNSTABLE HEALTH DEPT , 5087906304 P _02 5/2Si01 !NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. I PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, A%ZtAl-- S'M hereby certify that the engineered plan signed by me dated f concerning the property located at meets all of the following criteria! • This failed system is connected to a residential dwelling only. There are no cornmercial or business uses associated with the dwelling. • The soil is ciass!f!ed as.CLASS I and the percolation race is less than or equal to 5 rrunut:s per inch. The applicant may use histoncal data to conclude this fact or may conduct pre!iminary tests at the si,e without a health agent present. • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will not be located less than fourteen {14) feet above the maximum adjusted groundwater table elevation. rAdjust the groundwater table using the Frimptor method when applicable) Please complete the following: P.1 Top of Ground Surface Elevation (using GIS information) t t B) G.W. E .S levat on _ adjustment for nigh G.W. _,r ` d (QC) I DEFERENCE BETWEEN A and B SiG\tED DATE: lo\ NOTICE ! Based upon the above information, a repair perrut will be issued for ,bedrooms 1 i i maximurn. No additional bedrooms ue authorized in the future without engineerec sepl.c sys(--m plans. q:hizlih!c!dcr puccxmp Permit Number: Date: Completed by: HIGH GROUNDWATER LEVEL COMPUTATION Site Location: (���?� �A:�\� Lot No. Owner: _7—bwtS Lim176r AddresJ G+ Contractor Fife �ik1A 1' Address: Notes: STEP 1 Measure depth to water table tonearest 1/10 ft. .............................................................................. Date 1S 00 month/ y/year STEP 2 Using Water-Level Range Zone and Index Well Map locate site and determine: OAppropriate index well.................................................... MtW © Water level range zone..................................................... STEP 3 Using monthly report "Current Water Resources Conditions" determine current depth to O r water level for index well........................... ' mont / ear STEP 4 Using Table of Water level Adjustments for index well (STEP 2A),current depth to water level for index well (STEP 3), and water level zone (STEP 2B) determine water-level adjustment .......................................................................................... STEP 5 Estimate depth to high water by subtracting the water• level adjustment (STEP 4) from measured depth to water level at site(STEP 1) b nuitissiun: L-!SGS Well Data - December 2001 I'•t" United States Geological Survey Observation Wells s r� ice to Cape oi'licials, engineers and other interested parties, the Cape Cod Commission publishc� ntunthl\ !1 1 �<ttcr data uathered by its Water Resources Office. il? at r k:\�.:I measurements shown below are taken monthly from United States Geological Survey (USES) 11,Sc'i'\allun mells and compiled during the last week of each month. They are published as soon as possible there.dIci. I helo\\ Lire nine out of the 61 wells measured across Cape Cod by the Commission's Water ResourccS 01 i'ic rtinC are employed as index wells to be used with Technical Bulletin 92-001 to predict high ground\\atcr ie l ur Un\�:nik:nc�:, we've also provided links to USGS national and state data. See the i.i\l ik,h m in the uthk an.. 0o(flutes below. ,. r :urtlter inturmation, please contact Hydrologist-Gabrielle Be-Ifit at the Commission offices (308-36-'--)52,�)- December 2001 Departure from � � `Vater Record Record 1_ocmion Average" � Level* High* Low*�� Monthly Overall I (f3. rnstaole� ,�� 26.E*+* 20,E 26.6 -2.1 -2.6 13: rnstatlk: - I 27.0 20.5 28.6 -1.8 -2.5 4 14 1 4O7U I t ! t l !are ster B\1\1' 21 12.8 6.9 13.3 -2.3 -2.7 41=4518070020. it -1.3 -1 .7 4 1 110007UU 4\7] \ll\V' 29 -1.0 -1 .4 41 --,5 507()�9I 'M! Sand i h �>> 47.8 45.9 48.2 -0.3 -0.> -I 141, 1 8(t tC i, -2.6 -3. 1 1� I2 407t 20,E )ti! - I rur I S\\ 89 12.8*** 10.2 13.0 -0.6 -0.7 12020007li015; )o \V'ciIt! el \1'\\1' 17 12.3 7.3 12.8 -1.9 4.15;, \1_;;,uren�ent> arc in feet below land surface. �1c tsur�tnents are in feet above mean sea level. monthly low. �G� national \\atcr-level database provideshistoric data, hydrographs, and site maps. fh` t SC S compiles the above data and other water levels into a monthly, online \V'it�2r R�>uur rr n; t 11 rt that covers all of'Massachusetts. tt; : \\\�\\.c:ipecocicommission.org/wells.htm TROY WILLIAMS 1 SEPTIC INSPECTIONS Certified by MA Department of Environmental Protection (508)760-1819 40 Old Bass River Road South Dennis,MA 02660 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM�; 4�1i Ile-. Address of property J 9 8' 5A.-ca✓�,�r�y j/ I�u� , pu ,,,,.,L Owner's name& /'G 13 Qz,.I'7 4d Mailing address c to Tv d u7 X, 1 Grip SFp Date of Inspection 1 � $�a ► / 9.S S PART A ��`� ;�` CHECKLIST Check if the following have been done: S Pumping information was requested of the owner, occupant and Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. 9/1 As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The site was inspected for signs of breakout. v1 All system components, excluding the SAS, have been located on the site. V The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, / dimensions, depth of liquid, depth of sludge, depth of scum. V The size and location of the SAS on the site has been determined based on existing information or approximated by non-intrusive methods. The facility owner(and occupants, if different from owner) were provided with information on the proper maintenance of SSDS. Page 1 of 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION FLOW CONDITIONS If residential _3 number of bedrooms & number of current residents No garbage grinder, yes or no YC S laundry connected to system, yes or no t /d seasonal use,yes or no If nonresidential, calculated flow: Water meter readings, if available: ✓Q�« �- tI Last date of occupancy IF GENERAL INFORMATION Pumping records and source of information: Y 6 rl JN p 'bi 4 / h 1a✓Nti o- 77 O to a T �7G/ ^S /i. �r I"t�a K.cv,�- e�N System pumped as part of inspection, yes or no If yes, volume pumped Reason for pumping: Type of system v Septic tank/distrilmtien-beWsoil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no) (If yes, attach previous inspection records, if any) Other(explain) Approximate age of all components. Date installed, if known. Source of information: Sewage odors detected when arriving at the site, yes or no Page 2 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SEPTIC TANK: (locate on site plan) depth below grade: ! material of construction: concrete metal FRP other(explain) dimensions: S X 9 X 6 9//sludge depth —2 !distance from top of sludge to bottom of outlet tee or baffle u NAcum 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 Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert,structural integrity,evidence of leakage,recommendations for repairs,etc.) b d eo-'>s � �� �/t,���wa S G✓� J l 5 c� t/t.Y, i .-, 71; was vi o : •-, !i1��c� o f �-i.� w�.o� . DISTRIBUTION BOX: & (locate on site plan) depth of liquid level above outlet invert Comments: (note if level and distribution is equal,evidence of solids carryover,evidence of leakage into or out of box, recommendation for repairs,etc) PUMP CHAMBER: �i9 (locate on site plan) pumps in working order, yes or no Comments: (note condition of pump chamber,condition of pumps and appurtenances, recommendations for maintenance or repairs,etc.) Page 3 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SOIL ABSORPTION SYSTEM(SAS): (locate on site plan,if poss.;excavation not required,but may be approximated by non-intrusive methods) if not determined to be present,explain: Type: leaching pits and number leaching chambers and number leaching galleries and number leaching trenches, number, length 6 k,< <) X 3 S i>e' / ' /c ck C-i„. K s leaching fields, number, dimensions overflow cesspool, number Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) O Cj S .S <<j 4,S 07- �� ✓�✓ �� G �{i.. �.�✓ c / ti � � �O o-t � CESSPOOLS (locate on site plan) : IJ/iy 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 (cesspool must be pumped as part of inspection) Comments: (note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,recommendations for maintenance or repairs,etc.) PRIVY: /V/A (locate on site plan) materials of construction dimensions depth of solids Comments: (note condition of soil, signs of hydraulic failure,level of ponding,condition of vegetation, recommendations for maintenance or repairs,'etc.) Page 4 of 7 i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B SYSTEM INFORMATION continued SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' 3'7 I /boo y w l St�a 35 � i DEPTH TO GROUNDWATER o,j depth to groundwater — adjusted high groundwater level method of determination or approximation:/ / Page 5 of 7 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C FAILURE CRITERIA Indicate yes, no or not determined(Y,N, or ND). Describe basis of determination in all instances. If"not determined", explain why not) Backup of sewage into facility? Discharge or ponding of effluent to the surface of the ground or surface waters? A/ /9 Static liquid level in the distribution box above outlet invert? Liquid depth in cesspool<6"below invert or available volume< 1/2 day flow? Required pumping 4 times or more in the last year? Number of times pumped Septic tank is metal? cracked? structurally unsound? substantial infiltration? substantial exfiltration?tank failure imminent? Is any portion of the SAS, cesspool or privy: Al below the high groundwater elevation? A within 50 feet of a surface water? Al_within 100 feet of a surface water supply or tributary to a surface water supply? within a Zone I of a public well? within 50 feet of a bordering vegetated wetland or salt marsh(cesspools and privies only, not the SAS)? within 50 feet of a private water supply well? less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis? If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds, ammonia nitrogen and nitrate nitrogen. Page 6 of 7 I SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART D CERTIFICATION Name of Inspector: Troy Williams Company Name: TROY WILLIAMS SEPTIC INSPECTIONS Company Address: 40 Old Bass River Road, South Dennis, MA 02660 Certification Statement I certify that I have personally inspected the sewage disposal system at this address and that the information reported is true, accurate and complete as of the time of inspection. the inspection was performed and any recommendations regarding upgrade, maintenance and repair are consistent with my training and experience in the proper function and maintenance of on-site sewage disposal systems. Check one: �I have not found any information which indicates that the system fails to adequately protect public health or the environment as defined in 310 CMR 15.303. Any failure criteria not evaluated are as stated in the FAILURE CRITERIA section of this form. I have determined that the system fails to protect public health and the environment as defined in 310 CMR 15.303. The basis for this determination is provided in the FAILURE CRITERIA section of this form. Inspector's Signature Date /07 /� 5 Original to system owner Copies to : Buyer(if applicable) Approving authority PROPERTY ADDRESS: 14, Page 7 of 7 ' f oFtr�rgy1, Town of Barnstable AB Department of Health, Safety, and Environmental Services &AMSrMASS. ,0� Public Health Division A'FD1N0�A P.O. Box 534, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health March 24, 2000 Mr. Craig Crocker Centerville-Osterville-Marstons Mills Water Department P.O.Box 369 1138 Main Street, Osterville Massachusetts, 02655 Re: 171 and 198 Strawberry Hill Rd. In pursuant to your letter, Edward Barry immediately responded to the complaint and is taking appropriate action. If you should have any questions, please call Mr. Barry at 862- 4645. Sincerely yours, as McKean, R.S., C.H.O. Director of Public Health i Centerville-Osterville-Marstons Mills Water Department P.O.BOX 369- 1138 MAIN STREET OSTERVILLE,MASSACHUSETTS 02655 �,4`=ST��L OFFICE OF u WATER BOARD OF WATER COMMISSIONERS �i WATER SUPERINTENDENT TEL.No.508-428-6691 9RSTONS FAX No.508-428-3508 March 22, 2000 Thomas A. McKean, R.S. Board of Health 367 Main St. Hyannis, MA 02601 Re: 171 and 198 Strawberry Hill Rd./resident complaint Dear Mr. McKean: This letter is in response to a correspondence received from concerned residents, which mentions potential groundwater contamination in the area. I am inquiring as to what if any action can be taken. If I can be of any assistance, please call. Sincerely, Craig ocker C-0-M.M. Water Supt. -z, Cr},a.�. i ✓ 9 CA l j f 2 ���y t 1 l 4 X r i ST /5E i y ,}� <: r � :r.. -,d.t'�'!�`yr r;+'�i t : a :• , >. ,�� - , sCOMMONWEALTH OF MASSACk .:SETTS x ,. ==EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS " DEPARTMENT OF'ENVIRONMENTAL PROTECTION _ t ilC. - i 1 ? Ytl ay'l,�rl � ,�r6.'.0 4 °• . D IN PECTI N Alll= OFFICIAL INSPECTION FORM.-NOT FOR.VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM t� 4 CERTIF1�ICATION �r: ejxr:;Vf'c t 'i S:srt sr ewj r'F RTCYt �at,�Fy Sz .1P,{ BJyr.{4�.63f��l tx }k''1 ft `. �,'�' ® i a + •-..,i; {•�i i 1,ii r t4 rv§,i •b 3''rf jdi d- rk.(`F t Y, .r t ,A. Property Address ti DEC 0 5 2001 a Owner's Name. ' Owner.'s Address: "`' i m:. A r f Date of Inspection Name of Inspector: lease print)"P (pie P ) 444 Coin an Name: . _ Comp on �i r ,. r ftl yyli a& 1 c FY 2 Mailing Address., >. rin g f t s { i x ii01, 1 !, Telephone Numbe CERTIFICATION STATEMENT f " I certify that 1 have personally inspected the sewage disposal system at this address and that the information reported below is true,,accurate,and complete as of the.time.of the,inspeetion.,The,inspection was performed based on my training and experience;in;the proper,function.and mamtenance:o :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: rig i - _ j' Passes r ' Conditionally Passes Needs Further Evaluation by the Local Approving Authority Fails { a t:,' nub- �FY. . is co. :,- b } %f Inspector's,Signature: 4Date: %� ;. j 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 . .I gpd or greater,the inspector and the system owner shall the report to the appropriate regional office of the DEP.The original should be sent to the system owner copies sent to the buyer,if applicable,and the approving ty , BUtllOfl k1 y q }t # j F ,yo-.�t t ? S/a Rc� r� ' ,+ � �Vat,Dry ra Notes and Comments� 'C j /C T <.t r, 4 , iiirr1X� r`f t (qq .. , t"."^ '.'"> c .•� .?;r'kr^ ilv t I c.1 k"'•d°,fT'i:!bIt"t !}pdg Da hif.t`tiv •�. .' ""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 ( 1 , i, conditions of use r r t� < f A ✓•� i f : �#6Yri 2 ��� t z xV �1� ' s ] a+r dSe�x.Fx 1 ' +4Fir� F t l .7 r��Y���+��iF.�4 ft ii �R7 ri��,� -�.Y� -t • - 1 y ( Title 5 Inspection Form 6/15/2000 .t t` t page 1 �1 � 1. n' e D� r < f; � s pr�V } y�11 � �;��A` F`�•� Qi�h r ' .. . r,... 7 . � # -�W 5 3z •S r� -T r•. tf } '�^,tQ 1 l t � _ . .. . S .t..•t. , c,a .:t�i,..,sy;V'z..M.,..a 2 14.a.s��fin k n:•4..�..: S."' + '? { Y ! t Page 2 of 11 n • - .. . -. .. -. � - ! Ya ii'9' ii{5}�'�iti�.}���.+t)�Z.�� • �:t 9 sJ'ii1YF�'�k.4� Es�k'{f 1 �;( § �4t F t OFFICIAL INSPECTIONiFORM NOT'-FOR VOLUNTARY ASSESSMENTS' ' ..'SUBSURFACE.SEWAGE DISPOSAL'SYSTEM:INSPECTION FORM t PARTA: CERTIFICATION:(continued), Property AddressILI . x . j. Owner. yk r Date of Insp ctlon.f-� ,h } Inspection Summary: Check'A,B,C,D or E ALWAYS com to-all of Section D+ .. N.i�("✓ �„d .; •f� {„t�s A. System Passes t ": i'h I have not found any information which indicates that any of the failure criteria described in 310 CNM . 15.303 or in 310 CMR 4 5.304 exist.Any failure criteria not evaluated are indicated below. Comments { , is i B. System Conditionally Passes P 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.Lf"not determined"please explain 1;.9 0 1 r, t - 1 �. The septic tank is metal and over 20 years old.2 or•the septic taik(whether metal or-not)is structurally :k unsound,exhibits substantial infiltration i orlex'fltatgn�ortank. :Iauum-is imminent: mminent:System will pass inspection Mthe existingtank isre lacedwith'acoin I in sePtic tnkas4aP roedbytheBodofHealth ; .. *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 f q r"� t y a�y� k P3��{9i iirElfi ay .a r • f � ' �C c� 'xw x ' {'� 1Ft°a.t fv'fit t ND explain:' >T 4� it L7 4Tt tarp - t Observation of sewage backup or break;out orb' h static water level in be 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 Pipes)acerrplaced dP Z.` 7i %,[xa9kj'4yr -,f'0'�7 r° t°obstruction iS i�moved' �P S Y ! h ja',`tt' ° .�i. 5',•`f r r I k"' „ :, 'r,distribution box is eveled ar7acplacedf ��; ,�v fir.to dV,Y I'n R i t j; c Pt ESN t, i�,, `rdxf .>Hl'55r 1t" d"tr'frs' ,(s(L Pi!['r f t ND explain 4 ;' p ' 7 � ` - -.a 4t:'r M1 '. .� ., ;.. ,E �y'reffff•t^rq ��.F �i t � .Cl.,k ;:, :,'.;� . ,. - .., The system required pumping more than 4 tunes a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health) t ti t'{..1 3tiu .,.:rM4 1. T broken pipes)tiro replaced; z S 11 obstru�{cttgion is removed 2' ' r s r iY' P',H- !. i,°.�9 Mt:i �xt a r,�ka - -c°E�, �d� ,**41�6b:,,t x ',y� S y": t 1,a'' F w r i it S ♦ k 5 s RW 1.`P i� .}'� 'I✓�S S$F d - ' f �•T� r ,ti7 d^7 a a�K:T��"';J .�A S ''J:s 9 y k7 rkaq� ND explain: r r t �. sr 1t # 3 1.}✓,5 ,r�' }.1t+5 9 4 �F �} ;4; V« It $' r . � �..:,. 4 f f FT 7 �' welt 1 %'�d,•4� k � �k_j�F � L {fit 1'1.. -, d.. .. , � :ai ' f � {•, Jt a � ry 7{( h`q S tti i(^Ni .4,at kf r h L _ t f f � ✓ i 4 ds�. Met tr�r y; � ipss�" Y e � r; ✓a'1'` '� ��, � � ' - > Page 3of11,: •%,r r r �, a ,�rS i7' dFp, n �.Stinn N"k v,!�,. d. x y c d t 4,i f ,� a a� .,i°r r^ � 31r'•.-�.F���r�} Fyl�-`'++�`�s�'U :�C psi..,. �xh fi 2� i T «. ;r_. . ..� ^,;: €.. �dlar�6'r�ar✓ t,�ssf AMv ��.•t��. I['ut•° �ieti.+, `,� +fic :c fi YYI�S-. a j OFFICIAL`INSPECTION;FORM N,OTyF,ORYOLUNTARYASSESSMENTS j SUBSURFACE SEWAGE°DISPOSAL'',S.YSTEM,INSPECTION FORM . M` .PARTatAr ° I ,3 I CERTIFICATION(continued) Y ` � I �.} ,.'t* .[ '� p:;�sad s�.� ✓s r 5ii�' z k,a� ,x }r ' � z Property Address Date of lnspec ion •�t/DL�P i Owner. r a I. C. Further Evaluation is.Required by the Board of Health 1 T S:. ,k'.: •• J L ` [11:'yh-(! -'N'k � +1't ,x§ F :. .. Conditions exist which require further.evaluation,by,the Board of Health-in order to determine if the system is failing to protect public health;safety or the environment. 1. System will pass finless-Board of Health determines in,accordance with 310 CMR 15.303(1)(b)that ther,system is not functioning in a mannewhich will protect public health,safety and the environment: Cesspool,or privy is'within•50.feetof a surfacewater,<',L9 Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh ct' j. cw + rir r 4 ',i y.;,.r•t` s,Sf r `'lr` �t�CF.s a ,~F:"�1J !��� I t !f: I ,: .: ). j Yr 'i 7 f fidis�a ts'Li�i [ 2 '4 t i+r rf$ i ♦ b r6ji ,.� 5�li+ +ryb,.� ,F +J',ip's. .IY.,.,�1�lRgt+sfl Fi�2�s! '��.a{'ttir ),� :�F,Sr '•i 'il Irlt,4+'4• ..t'. {� '`c t 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 publkbealth,safety and environment: The system has a septic tank and soilabsorption�system(SAS)and the SAS is within 100 feet of a j surface water supply,or tributary to a surface water supply s �',< ,r s� The system hasa septic tank and SAS'and the.SAS is within a Zone 1 of a public water supply. ,.'k x ,..r v t -'..-w.r 1!'w•«'x:�r','„:,+"F:`.;!trKA , '�.9�:"' .. ? z ;� :r ::ns i,[ The`system has a septic tank:and SAS:and the.,SAS is within 50 feet of a private water.supply,well. a septic tank:and S 4 The system has � , `�• ": -� ��� ,:; .. •: ,. - ` AS,and the SAS is,less than nt,100 feet but 50 feet or more fro a private water supply.well'!* Method used to deteriaine,aistance • " .<n sl ritf�t. w%!zY $'4�';.9k`, r„y:1 , �9 *r rCt f ,.;v:i,t -•.-- j„, + "This system passes if the well water.analysis,performed at'a DEP certified laboratory,for coliform bacteria and volatile organic compounds.indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is.equal to or less than 5 ppm,provided,that no,other. .> } failure criteria are,riggered,,A.copy,of the,analysis must be attached to this form: , 4 S 3. Other s'"` � F �• t iY � t,t� ,I,t t a�;i' t fY1,.. r . o c-<:;-tin +r..,;:gf fa a >r r !,'s,•e ,+_�:4 7 u t, P 7 yJ d 3 y4 r a } v • A + ! [ , y r � ry �: �" �5,7'd9ri yl� )p :1 e1. ;�. r 1 ;Y i it 1 .• - - +r�.t d 1E ��,Sit tk� f }YX�4.n7�1�r>"' A•SP 1 �y'Ef r4 t���-1�vNi.5t(� �{3t Ll'�.}{�{,�b yYt1 n 4r P�{5F t3 ;4 IY r'., .,t �-�1 ..Ivp' 1ti'� t�is � ' F + 1 r st - 3 r ./I't r �a eti { al�t y€' r13. k'�r)�N� +J�l�t• � e i.. tr.. ff".. rW ,n�:7 R�.i�[4 k�4�r'e# `fit th,J• gj$`,� }x t01 c r l +• :.. :....1 ` 7MN t�i [ g':_ r 1 -q Y :j 1M ; t :. t .. f ( ti b i t r "Kt'f4g��1P5; g "✓<+ t' .G t 2 r y�4 Pa e4of I d kk e t.,,1• j= M y i sssr d i "•r t %a,~ h r' r �� f�'r ,, & �u."_ vrr ak §t x, n £ r. t'}r OFFICIAL"INSPECTION=FORME NOT- 'ORVOLUNTARY`ASSESSMENTS` ESE S� �SYSTEMINSPECTION FORM j 4 ; CERTIFICATION(continued) `' r k !sn t rY r (.t+,Ar. "4 4, g k Property Address:,,� l��� Owner .hhn"M'It r., oalOQl z k a Date of Inspectionrj , D. System Failure Criteria applicable to all systems .••. You must indicate:?,`yes"or,"no"'to each ofthe1ollowmg for all inspections �'_ ,.4 Yes No . Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool Discharge or ponding of eflluent'to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —N� 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 tunes 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. y } i-. ;� 3A .i fi {a'-e' he�R.Y.; Yr�t..4 to ran}..� '•{ Any portion of a"cesspool or privy is within a Zone l'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 l00!feet but greater than 50 feet from a private water supply well with no acceptable:water,quality analysis:'[This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is freefrom`pollutionfrom that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less thaw 5.pp�,provided that no othe�rfailure:criteria are triggered:A copy of the analysis must be attached to'this forma -rah - f. e5 (Yes/No)The system fails.I have determinedthatane?or2nome of the'above.failure criteria exist as described in 3,1 Q CIVIR1,5:303;therefore"the'system.fails:The system owner should contact the Board of Health to determine',what will be necessarXto correcithe failure y.. !I �, r s�$S ��i it c9p ✓� t�ktay2,.t.� !d h f r � � +r - ` ':}{ • .„.7� 2 3�1 P a.j ly! } p1j 'f.�� Y1n6�1 1!X�„�f� E.+'Large Systems l s}2 4+ {CkT{ r i 3 In��ti�+'P 4 r3 `�t.,"'�3r I���d?.,,>2 To be considered a large system the system mo ve a bdWyr"a dessgtt flow of 10,000 gpd to 15,000 . < i c 'r �tiK .r yr v r r gpd. a r � ,� .N >�+ . You must md�cate either"yes"or>"no"to each of the following "; +r ' (The followmg cr►teria,apply to large systems w addition to the carGena above) rots[ r P f ,'e' r' T ! ``•t } I �: , -lrrtq at''.ftc'�p s''t tt° H✓ '1tF�'�,rt v�`'`s��" jyes: no t tit 1y 7'e r arr k t . a{a x•:q r ,f�,.3iC y J is h pr d t t to t 1,r It k the system is within 400 feet of a surface dnnlcmg wad supply `+'y ,`- , y,7.; a s.�� 'y -.,• Y5 ` l ,. :���-C`��� t +f ?p�. � .}'✓ A+1 sf �. 4... .. the system is within 200 feet of a tri utary 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 q. t ; If you have answered"yes to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has`failed The owner.or operator of any large system considered a significant threat under Section E or failed under Section D.shall upgrade the system in accordance with 310 CMR. 15.304 The system owner should contact the'appropriate regional office of the Department. f�r�dt.3yt arj"l t tp, a r�rkl _<r a AN r' '£ ?'� # 'a , -ts� t.a'a�• j! .'r"r,S Aa tt a 'ro a'•'c.. r rT r � t t tx+, Nt r t.+k dX'4 -,r# , r� ��} {�`e`{i F{� 't�'k+. �a t�-��,i�d x x_ tr:• c Peo11 p E t t - �, J S.� •r x t I atl5f �, S 1k4'tfGrr. t �.,1 t - .�# 1 ks {.{, t,, �`Sc F'' &txK7e Yirr.S ''yi t« SM . f s;:•:,t•{ { :>&z3 n.'..'tr. r t "pF„w. Lt s1t t;,, frvvri rri ar 4' ttr4 :•,,+• - OFFICIAL�INSPECTION;FORM";NOT`FOR"VOLUNTARY,,ASSESSMENTS SUBSURFACE SEWAGE.DISPOSAL'SYSTEM INSPECTION FORM f APART B „ 17`P�CHECKLIST ` t } f e , Property Address. I Owner. Date of Inspection.-°IJa,einbeIf 7 , Check if the following have been done.You must indicate"yes or"no"as to each of the following: j Yes No ' — Pumping information was provided by the'owner,occupant,or Board of Health ., � � :.., Z t�.• � 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? "` } — Y' Have large volumes of water beenl 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',?,,,,' ¢t 1 ;t R i Were ah system components,excluding the SAS,located on site nl.• 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? ' if •��` Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? 4 . - / t iZ `.._{� w ,F. r} a=t��I`�SS sbti 3 S i t7.4; t jx "t r �-x•- > ' r `i The size and location of the Soil Absorption System(SAS)on the site has been determined based on";"' � i Yes no,.- _. Existing information For example,a plan at the Board of Health."' z,. ' ` - ,i a.t �':Y r `n ;' r V .✓•`:..i� f } L .. .. .: 1. .t.. t Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance . . is unacceptable)[310 CMR 15 302(3)(b)j rC( k k i • r�4 #1 M {�. 7 .p"i�...a tt Fy.�(tdx =t..F.' {,\"Si �i;wj. w,°+f1Y tY' �tr 7.,ti3„x'•-tt '"1}ix`z, wh y�1�{ t t f J: 7 L i Nt ..£ S^{ ,.� 2° f �Jtif tr PEES `n�l,'.*v f J.»>sda3 34}A.ro't�x •`x�t�i�i e �F 1S2t w (;a 1 v: r f 1C1.1�r��5 F}�tf bTjj1. • ; .. ." t.., sir '_� J i y } �A eta Fri Sray '� V F '..i#ta .' S 1: Y ;t t s P f r t cg ` # t. a n Esc t�tGc'�£i��"�>� sAt�sF��"��fd�r0^ 1'tvt t•:� 'i ? t � ' i ' r^. 1st {k7°`,�i�•Er'Yiict to Ea'�''7>A����r7���*�a"�'�S`�}v �r�r fJ aK v'f '.1't�"+�t�F 5` t � a ;el l r'' c ,.. b.. { 7. !S ''<'Y '7`�"'r': tF:M •{3 k; .�. f 4 C 'Oi A ff iTfW 1,j7 S t rr,r>,.'t t I ` is � y a +�x +1t a; it+r �� i�r �r sf �. 1,>e'1 a�� ebul 3 1 _ � i • - 4 !X 7 Y F •1 •' -' 7 � r r I' Pa e 6 of111 a�Y a�y�AS.,'.' r>> M yw F a�C 4 4h �� d$; �r 3, 4� y �1 I - g� 5'... 19 rj. tT ik, Y rt7r, i1 +vyrl,nq.���4,�e ^'h'S ,'gL: r.'�S > � , . + tI I. II t:.. 4 '+ `� s t ! "+,�., t o rri' d.fir' t a.. } h 1 - <9 r'xr4 k ri`�` k �4. t'• 3 v ,e roz{wk`,� i - !k ft f .�ey. t r.. ! ,i gin.. , (+""..;`i "" c',k`:,,J,,z�+.:.`C ci;.,r=JY3`} , " W -_r; F•.,r�s��,'r , ', x. + OFFICIAL INSPECTIONA:FORM `N,OT FORX0LUNTARY,ASSESSMENTS SUBSURFACE?SEWAGE DISP::OSAL SYSTENLINSPECTION FORM r �'-'hS PART C•,Y,.f,' ' k =_ , SYSTEM,INFORM. TI N - ^ - V 'tt ''*c .to- :,A a a x. a F. y i `4 4'x' :y`a +< f...' - ! 'v .'+�' i {?�', . ?�`S}1 'sib}},t:,, rr ' 'i ,.. '-t.' 1 a.' { - .u ?,' , 11 Property Address r t .i.. .. .,. Y . 3. ...6 . .. .. T ' 1 , , V Owner. • ,5 n'`.'C1 L.rr Id-' ' Date of Inspection z . ,z , 4 . £ 'i,^ � � ' > LOW CONDITIONS I' . RESIDENT1iAi: - i .' If a ;? a ,t b i"„�F"` e' ,;; ..' Number of bedrooms(design) ' ,•, Number of bedrooms(actual) ; _ ,:,, _ . �, DESIGN flow.based`on 310 CMR 15.203(for example ,110 gpd x ref bed rooms) ®���. . 'i Number of current residents.'I _ 1 p 4 Does residence:have a arba a der es or no , ` ;.7 ,, ,.,,_:f Is laundry on a separate sewage system(yes or,no) p npfyes.separate inspection required] Laundry system inspected(yes or no) 1J I T ' $ -1 Seasonal use.-(yes or no)` J e '• ,; . fi.., i 'Water meter readings,if available(last 2 years usage(gpd)) 1999 8�0 (74 000 8/,0009,o/ 6,;O,dx/ 33eix , Sump Pump(Yes or no AA y #-,' r�> ,'i i I� : : g y a )y; P )1� ,it 'i ' rP �ai �14b J t I`tu€i;f��y ; } };k.- + J .. Last date of occupancy T t t t f"e t a', . a :.- k '`'� i , x'`- k 4 11.1 ° ,h F,lf wS,"''th a'� ae, p��p rt�:: iw t 9f�af p q�i%,,"sf , A a : 1 ' tl!r R 11"t is}r .,J` r , ' COMMERC1iALMiDUSTRIAL Ik _f m: 1�,�' ,' w ' "Type of estabLshment'� �" fr , l 3�4 t k r ,{tkya its rrrll"+,1 x! a 1 c i 1 t Design'flow(bated on 310 CMR.'15.203) ► ` :, ` , and r r I ",Basis of design flow•(seats/persons/sgR,etc) f ,`t .'ti ` Grease tra ' resent es or no : 4, "F # f, �$ rf' a`q F F ,A }Y 4 �, ,I J t Z Industrial_.waste hol, tank present(yes or no)� i Ry 4 Y�S [�� {# *1���� d3R{S D�F !_3 !11 f, r It r R �1 1 t ;. Non-sanitaryfwaste.'discharged to th55e Title S system(yes.or no) �, ; ' Water meter readings;if available `", r ry ;, ,��}>t t; ' x s ,'' Ar «`" Last date of occupancy/use + r w � "> , a ' ti ' '� t t, or, �+ �' f° x �i L:rgk S a�� fi{°o tt{'•�¢jh�r *"�iir �szrrti bra} Cr',1r''y4�f,., t� sk{', 1 +.' •' 'OTHER(describe) t n 1 ,, r.: - is ,1 x h,, s�, t ' 41 Y I,,, �S t_T t FJ„� { ...^i' ,tS�.t,.��� rF :lkl, , t(t4 :Y':t - •f .. ..4; C FO TI• {t ,;1; ii>` s�'`t,4' it ', �r'�a t!;{,j, ,GENERALIIN fRMA ON'# — - � = f 4 ; , ! z Pumping Records e3 + ,fs 3 AJi. ;,"J a "i' 4�!7 'lt..;t`ai�r j.,) 'a r ::'; j 1:; s .. , r Sowce,of,inf:"I .1 on =' ,I_L V ;;Was system um ed as art of the ins echon es or no , � �,r`?� --, ,,t, , N ` If yes,'volume pumped allons =H_ v,,w s quantrtypumped determuiedT � Reason for pumping] "'—'$. �, i f . R sx 7 . .. A-. F f } - 'fYPE OF SYSTEM �, °, %<} ' Y , a t l t 44 �Septic�}�p�„y� "distribution box soil abso}�twn �„ ` M � i ; P ..""�Y. y. f , '!'4w e' 7fi•J�'u 5�x{rci t .ca'iSlir... +8'"r°t i i+\t��tt a `� 1. ;:4 `,Single cesspool , ,' 4r+ G, r n a„ " r z Overflow cesspool " r d 1 Zt, r ,' . ter Y rrv.t a t�'r x 3 ;Fa'...:) bjt. y- �.� ���' ,+6< tt t n Yl ., S3 1 +1 a f� 1 ,,l,a r. a v zz ,i u N& s a a� e 4 I � ifi b tfP _1 t Vtl }{ _Pri•J , ,^ ,�:,,':. i,a�s �` :' . � ..�e1--'f�_."a.,' } yb,'�., ri'.; -a r'��t ry+".1� Y 4 4 }t+, ' ,a -,:i t I. a, c:.. ..,.•. Shared system(yes or no)(if yes,attach previoos,inspeation records,.if any) ' - � .Innovative/Alternative technology Attach a copy of the current operation and maintenance contract(tobe . S obtained from system owner)t ''; -' fr. . ,;, 'A,. , j r{ ,,f`; t-, , ;_A w , M Trght I } ''Attach a co of the DEP a roval 3 ' ° ',�. ' PY PP �Y a ' _ y.. .:l `, l�''�',p ,n,'J c e ,G tl`-r. a,. �y j r xy xy i .r s ,`" F t 'ram r� L +l 1 -:�' l.j�.,,., f �,* c;s. -j Y't+..s •'�F'� Y Ta j.s!^V wSt�a ak ir�aTha rr� r!s t, e f ,k.t.+r -u l,��3 tf.s t�s '+ ,; s P 'Z; i^,$a t.'+" ,.. ., _ Other.(describe) F .r . i rE xt+i 5.'rvey( t�'_e't f :,4>" r x}., iu .#} 7y"at yl r ",t �,a t t 5e e -r t. { k... - - 'f Approximate age of all components,date installed(if known)and source of information: j t3 .3.4':, r .t t.J, a' . t 's,('t '3 a _,, 1 1. a ,�.{ - :'r t ;... c. ,. r siyq,;n+.J3+StY.'t 1a�. 1.. J" 1. .aJe .. - r '.. 4 # ",,4„4-�. v r c^. tu"Y, Y' k !i'Sir C"".'t x,, 1. , ,;. Is ' s Were sewage odors detected when amvmg at the site(yes or no) e5' �E '��,!;'l,� }' �'t + }: 4rF ++ t t t4✓ i - /S}}1��;'t�¢iy++' 'r, fd�o VL FS., fi ..p 3 .,a�.�k, f 1 �[ , it 3 slr 1 `sa -�"Ar? {t ,h"G' ,1 a i.�i 9i�'t�> s�r'��� t�r ^i'"k-t41 �fit' ti .. a t� .s o �r r 1 t r +�{S ,.`rye ,' 'lB n ! n f s,.! !, k'. , 1 r :. v a M �?(e A'- y, ts,YY` f k t.h t..' y to ,�� fi k •' t 3 + Y L' t r +M + h h.1 R„r ' ti. yy�:::� 4qk, ,. _k C' h "� yy r aSl t1 �'<a , Fti✓2 r� .#f 1G,,'t t''.. { L ' #z Vey tr ;��- ra' ivl,tr t..t sa, ztiY� tie 5{ ot �li A' "- t thra`4f'}i�a�'A , to , , i + 1� t f ,f J J..i`•a t, b t S t ;.r7 t�,n° s'` eiy, t r;- t �Ti' y > s' 4.}rrz x,.rd vtz*'�y� -'•t scK r i r s tr r � 'F� � a''^ 2 :t. s t ,' . . •.ttita 'y_t s es S 4. % s f�°+."sa''r2.f,j:Ar�X❑y`•nrY g x '% r Pae 7 of 11 V1 i % fYy w fy F S y4 y�Ph 7+ (w at 3 3 f�} Y Wf3p J }4� 7. g sf 'F' 3 t 1'1,h S'.Fw4s .+r,, `y�y '�4a,ffi�f 3+'7 3 S t't r{ 'St it _ t , � � �J� � .� t � ��tyfxr',fs���"m'`�tt.�4f•�1 ��r�"a�k,��'Kiir�'s���,�{�4W L�^ F f, 4' _ st �'r OFFICIAL'INSPECTION„FORM NOT FOR VOLUNTARY'ASSESSMENTS r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM rya %%PART C�� "SYSTEM INFORMATION(continued) r 1 :". � trez ,r cF1�f ey z nZy�� � b i , � _ •,e` Property Address. �9 ' f, f T /spy z 1 Owner:'% Date of Inspection /Unman . r�23; aQJ `fl BUILDING SEWER(locate on site plan) Depth below grade .' r S• 3 ,,k .« M �.s e ! Materials of consttvctton cast iron _�40 PVC_' other(explain) ` ' Distance from private_water supply well or suction line- Comments(on condition of join venting;evidencerof leakage;etc) �'j ., r., ,_ ..rx ;�•` �.a s ,�`"S":.p�,.r !•e`FiF Y:. .... r. t% 4t {r• . � l SEPTIC TANK —(locate on siteplan) t F ,. 1 , ,� Depth below grade:•%_ ' Material of construction: concrete metal ifiberalass`_polyethylene xr _other(explain)'' If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) t F • 1 e5 y-,^ , + ..` ( r S�3i 91yi.Jx '`'f'� t� .M1�ts''�f Jat3 =S )� %;1 •KL � � 1 :-Dimensions 14')OgA ^ � t.:t' // •ro;A�;.y, F.;ii,. .'Sludge depth 9- Distance from top.of sludge to bottom of outlet tee or baffle - .- dui r�s nKe3e•1 r�f�`.p'tpk�a1 «F�tfk"S�'a� i y�F e15�y�'!' Jf�1 ue fl� t L mke +trtit J 1�§ d r t Scum•thickness Distance,fiom top ofscum to top of outlet tee or,.baffle 'Distance'from bottom of scum to'bottom of outlet tee or baffle HoWwere`dimensions,determined. �s�ruJ►�� r :` ,r� ` Comments(on pumping recommendations,inlet:and outlet tee or baffle condition,structural integrity,liquid levels as related.to outlet invert,evidence of leakage,`etc,). .; ,i':. ar hu)� z�+v -rt GREASE �TRAP: (locate on site plan) r �, w .r..r�:•rrrLHL.t V'{.".y+.i ''t',m,4lrtklr..za•'...k;.. fe•p+a+$•,,; Ji r>r. ;A f,r •.a lF+u'.xM pc > kY'" [iY9rd'A 3.4.wktS *ul- f . .:. t ,f}9k�.r�,' 1# 4• s .F.., is 1 c _ >~e s3 4f � '� �><+ .r,t ✓ ..: if e.:%. �7v pr TM...x, +{r,.E:�•..�. x Depth below Bade rid" Material of construction. concrete A' metal ' fiberglass; Dolyethylene other ex lain ' f ( P ) y� ' � F an�.•w, h; �'' -+`3�k Y�zs t�lsf��t^rk .i .�a a r , � �+ a i- ' r ;SCim t�11C1CIneSSF.+.J 4. '_'. ^i'.i, ,; :i '» v t � �' :'six Y `i � rs`4�H�' :a 1Ya4 kr'•_ ,, ,�,Distance.from top ofscum to top.of outlet tee ot�baffle �`�'�°� f+ �.+ �� `� ' J r u'•Distance'from bottom of scum to.bottom of outlet tee orJ.baffle w Y r,o, �,:� Comments(on pumping recommendations,°inlet and outlet tee or baffle condition,structural integrity,liquid levels Ias related to outlet invert,evidence of leakage,etc) $kYk. {{ • t .. ::' `b.''..• t '�,.«st ' r:�' ` „�f-Fv; ;�r<r-'t� ���� S+. a'' r" }s ', 4, jSz-. .. • .. r •.3 •xr 4 t ,�:' �?� Nr_ ,kit y sk B 117 i Tv J � j N1,rY -� ix { y 1 � .s�f t . f ark+,tex:�4 .M-%'ti;je�� w r •��� a a +` 'c x o t ' •+ Y z •,7 ti'+ n.x ♦xt r:. y. .r t $ t,r.� ... l,,. a �i.L., .. •.:t t"f'�Y�.�a 5"1 X f 1...y,l kn ' — '.r<♦ v..a.4,. . .. F 1. ., .i .... t,. � � ki fMjt [.y.; t tit Ate.`` �' try hrr ��i'pt•K it..,^'h ' - q qi � ;_ 4 Page 8 of 11 g . , i.�'t �..�3� } � t ���y f a v»*�i5s ..S.,s'tG ri1�'�su{j{r`ki � �,r,..+,�t #r J^.�4t' 4 tt d• i • fit, 1 1 t - � _i t i r x ��.'? K � P-.�{ •.2 y y '�.•��i e� �S`4f 33 ./��1 ik `��.L x s .. Y,t,. OFFICIAL INSPECTION«FORM--NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL'SYSTEM3NSPEMON FORM Y„ {. } , Y> y ,.�t.< ,k PARTY' f A SYSTEM Il�TFORMATION(rontrntred) Property Address N Owner:' Date of Ins e `ction A/ar�emher�3 � r� ' ' i z TIGHT or HOLDING TANK: (tank must be pumped at time of inspecdon)(locate on site plan) , Depth below grade: Material of construction: concrete metal fiberglass,: Uolyethylene other(explain) Dimensions: F, j Capacity: gallons-'.',, Design Flow _t.:,n,,..,;,__ gallons/day `. a,. r Alarm present(yes or no): a t Alarm level "" 'Alarm in working order,(yes or no) Date of last pumping Comments(condition of alarm and float switches, , • 1 t f'' 3 4'i?• �,';rtt t'yt tr\fY4jf t'S «si,w thlai«1` (ifpresent mboed)(locateon site plan)DISTRIBUTION BOX p f 3 ^ Depth of liquid,level above outlet invert: '1 Comments(note if box'is level and distribution to outlets equal;my evidence of solids carryover,_any evidence_of leakagpDe into or,out f ut of box,'etc.) � 1. •...,.✓ 5� i r?.;' J ..r,ii,!$ y.l;±{j.°.; ( r.< 3 y $ .�k «„ , ! « a \} f�.d f t •` z,e s r ti �'7 !a i^ ' i i 1f t\tt r 2 ) ';,'v t/ _,., 4C is PUMP CHAMBER (locate on site plan) p HM. i- S� t'* �•� 'i .. �� N1.. � t 4 t -� 1 � ry M. L�.W .. ..w - Pumps`in working order(yes or no 1 i T..`�t,�J'•t-y j 4�lyM � } � f } , !�' _. j :t �� f ,Alarms in working order,(yesor,no):' �� + s + ,.,;;• { �.;�* rs tt \. 4_, } Comments(note condition of pump chamber;condrtwn clfpumps and appurttenances,etc >r5+ ii a '1�' ... t t, 7 i,.t;,17 .iAr..'P•Jt . 4 _ ,.A & )' �t e t �<�r♦f , JAf*..,4 t J'.tw +k r S "' yk' '{'•f Y fit,, 4F YS F:�' �F T`R f.:d Y�r'"'4� T '�A } A �A }-F: �,.. Prtx � d Z �, `• 1 [ Jit S ! dy Y 4F `` ib q c a Yc }t+ S fit iS f 3 ><..` " 5 ; k`�egy� t�v t,a•o}yi-, -R f d ) t . _ b '! , !a fl t 3 +am a a. +3Y{C'+3"M'At�g��i;d T�y7 <� �,. ���n.� ��f�r�tti S•a}�!r,${('�3° w t t7311 1 t rt�}i� i�«'i;!,:j+(s, �d.Y;r i �f,b 11!1'i a .�{: "f �ttS�ffCJ'*�r w,;P6�,���,"p SIfi '��Yt g,.�7'{'E.@�i��if p�ilf�7��c tl Pl ii P.t it ;;"` �P:;,•3 , 't: t r! i , ` » A M Yy t t 3 •b.. '+ mr.J ate` ri y rqF •n+ '^tc k 1 r .+` , v 1 JiY r,K'.t. 7 4.)'°'�y{tb..N.+.� s n-E� �':;•ti'.,�,•e�..a4 S r. .r..< ( t 1 t .(,•<d >: 1 } '^ c«j r,rr�n � � r�K• �, i Y� a r r i � j{ \yy�"iY6 s�f a ��r t �"• -n 1 « J KCMn t ra? t"- } z -h ,« a r v is w"�z•�t t•Fy F a ,..r r f F_rV ild t"' •. 4 3 y ! R :-M Y t / ,� J'4v^vr R 1 �G 4 i'F y, * � t t js yAq 7 r t a+tr rti AF lt. -•� .Cr �.zt .. i I ++,` :1 r '" krs>tt +,�.4 D t'lAat a �+�,+r,. !g x Aid' ✓:' r j ` Page 9 of 11 , a i t S qn a ?ryf a x Ji w w rtt1e e .OFFICIAL-INSPECTION,FORM-* iN.OT FOR VOLUNTARY ASSESSMENTS SUBSURFACE'SEWAGEDISPOSAL"`SYSTEM INSPECTION FORM { `r PART'C yS,SYSTEMINFORMATION(continued) Y-is�1,�{ c .r Property Address Y f d t F f� t h A 4 �� • Owner. /1'1,33 i Date of Inspe lion• �(/huemher ,� t SOIL ABSORPTION SYSTEM(SAS): '`(locate on site plan,excavation not required) If SAS not located explain why:,! Type leaching pits`number: leaching chambers,number, r . ` leaching`gallenes"number F .� .. f ✓ leaching'trenches;number,'length y leachirig:fields`number'idimensions 'a",k'"� �a ' overflow,cesspool,number innovative./alternativewsystem:'.Type/name of technology - ' Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil,condition of vegetation, etc.): F ; oil'is YE a r ji. ji .. �� < s,;,, Km ..w3 Fz'it ? t�.: � � r..� ,.,- ° r���z,,« s�r y a'e k�u'�.zi 4' •wad' zk __'" i CESSPOOLS (cesspool must be pumped as part of inspection)(locate on site plan) K ..^'f ,yl',•,z a* J �r� r t r -' ��'�' 7 C iP ni t ?n" < - r` k�, - ' Number and configuration t Depth top of liquid to inlet invert:, t Depth of solids layer ` �Depth`of scum layer;F Dimensions ofcesspoolr 5 ,:.1 t y. r-�]C1 � ,c�.;y a�tsu �,j�*y.t 4. s� sFq* r 3 14 �.• q Materials.of construction ,, Indication of groundwaterjnflow;(yes'or no) I� Comments(note condition of soil,.signs of hydraulic failure,level of ponding,condition of vegetation,etc.): + `� r � _.,t ♦ti w.� � r � �fd Jt, � �� ai tp a ]kt, . 4J nt. PRIVY (locate on site plan); Ottt Ak rT��F#�'t r T'.� t° Y Materials,of construction Dimensions. htai rK t g #r l SA wSJS t e t yp y\lr ky bat 4 4a Jy ry Depth of solids Comments,(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): ��d��= h.x 33 �,, F h } � �F{� 5 t t a�•nr ��fi� ��a�$qY9#� *�� v S:'Y i a , t t c:y ' F4 a,d y q, ti ; ta , r'st' i ivy-dry ds s S 2,,-+fr4a �' S j A 5 ti 6s + 1.t dw.. Yt ! ar .v t .,. �,Ji. % . 4r 1$,. ,`% ,y, S`5f l rF LP"d+S.`''.�JN'It' •ur'%i yr -{ x�`' try ♦. t r N: `r tr?�i: �s a A'a ,3 o, w,f A ar �Y._ ;"r , re,�`: ... 1 % Pappe 10 of 11� ,,� w� , « � r� ., r Th ,. Y� c.•., ,- A:F ,,)"iS> F it,'�#� "ZjW s*Ar y $, �-L ez d�'4* 'i f,✓t, a s 4 1,ky s , t k; { ' a 1 FJ'F.,!s Sn�C e'ti",�, �� re t}+. 7l°"P t �a:�k tr J F C1 . ,+ .V I K iij �",y Kr 2 Y r G iy,l ."a J 1 {,i;� f,,at .Nt of% j,a a ,.,t s-r. J ,,..,i, �1:.:. t, .,n-k.,.tM. X; ^;yc�'4r`4V,d.14 , N ...-:',�7.�..-,;.r.< OFFICIA 'INSPECTION=.FORM�'NOT`FOR: OLUNTARY,ASSESSMENTS' `SUBSURFACE+SEW.AGEfDISPOSAL''SYSTEMINSPE("TION FORM11 ru- ,� f - ,PART C x SYSTEMtIN .ORMATION(contu ied) y , - .a i ) r C' �cZ ,, qF_ rr r -h y=9 4 r ^ r "r n t - . Property Address r Y , ; `.Y s w:.; v ;:' _ OWner'S .l i n . ,,. :r Date of Inspection / ! f�}3.s '-1 d s ,r� f t t ka ,Y a w Z,; v ,r i ? , 1 1 ,r d ar r nt �. h .v eau F >,vo u+. +s. . SKETCH OF SEWAGEMISPOSAL SYSTEM' "1'". °.. . i , I. Provide a sketch of the sewage ilisposal system including ties to at least two permanent reference landmarks or i benchmarks.Locate all wells within 100 feet.Locate where public water supply enters the building._ s , - .. I. . , r, t . .. . ., . , -' . t v e '- .. -'. 1 r j I �''p 11 II ku.. tfa t- 9 [�aC tid t r Rr. , ,. _w i t - -�} t ?i if?n >.f �:i �tffY Frr.Ps,11't1.1. `7 Yf a7 :ii�s 1'�Jtt .tt + y ,t, e r - af 1� r ; ';t ':F! i r a r 4 1. 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I.. ` ... .re'fe r t tt _ "• �}'' .a1 "r .!w,�Fjr .},; te!''t 4t'`tttf res „J - t ; Page 11 of 11 =4 f� yt2, S f hJ }1 � sL° P, ei t € F1 i { q} e t. A s r r rqx# r rrz - 4a x+n b y y,r*'z't'rI a 7`3e r r i vk' V r r, , I +. I uy}2 )4 a3 g'{t wr 4 x r + .x r} iI r r 6 .r rS..F �r..r ei tr ^.`` .. fi. t rXd.,T1. ;L. fir+ �t I, max:- 3-' ,r , ' ' OFFICIAL'INSPECTION FORM' n N I ..j F' R4 UNTARY'ASSESSMENTS . . SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM r t �4PART C, , ': f . A tY� dJ * Y. r v a SYSTEM INFORMATION(continued) . j 1{, ,� e { c { Syr :.- y a r r(,4>t< ti Sty kt ! 1 Property Address }A ,xa. t �. k az ( ,t-` '.r.- �E •;� '' a 5. . . _ :t... 1 Owner: a;z � `4 [ i r I. Date of Inspection 3':0100 ese'; f SITE EXAM ;-' r ( Slope r , I -`a ''{ t tie �`' s r Y ' ' . ' Surface.water t . Check cellar' t �f � ' ;f ;,; a, x ; ,t Shallow wells .s 1, f+ , t t .j E ti x"',.�,rt Z:'�d z'; f n;'1r x e �'1 r t ac e - - Estimated depth to ground water feet 't t e z_ , F Please indicate(check)all methods used to determine the high ground water elevation: . i t+� d M1 fry,y e ,?A i 4� T, III} Obtained from*system design plans on record It checked,date of design plan reviewed: ( Observed site_(abutting property/observation hole within 150 feet of SAS) ?"-` { . Checked.with;local Board of Health-explain , Checked withylocal excavators`uuta1lers (attach documentation) r I . Accessed USGS database-explain• `t r{{ ;� {r,kx ~,, !✓z "`, ,, ; j "" t e r t 1 ''a y '4 -� r� �i 4w r , " Y{ '� 4 �` I f .. 1 r: 5 r *. 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( ! �, r#S 9 R A r t r 6 r, 7 'rye � Z. t r h,9 r 1 t 7 1 ..1 yF r 1 { 1 r ' 'rjt Fi J 4 r c t, t } !k tr n r r, g + t t,./3 " Z t 'F "�y f'r - M e q3 r t Y a y.k ,, y aJ p 4 L r Y t b L Y# 1 h yr'ly•JS r`�G $ 13 e.; 1 4y 1 {.C'j' t�} Y 7 - a t a�erw r t �e=-rc•�3rC r t t},- Y +i J}�t r cJ r h `�y4 t * t fs -{J a y+ r r ,r h tl -r i F a,t,,rq T'�:7 t ' 1.. tt e'r t 4t{" ia'I' f t 1)! r 4'R'yt r ,y rs !� ...'{ "t F ,i c> II 'a ! 1 -�t i ty r rt , {+, t5 eex>' (-!1j �. s�'�sY`v�"..Xie't"I �4 t Y i , M; re b ,{ }',,, e r X b 3r . '., � .�q' . t✓ ? 1 z ..��} /r^ o �` +r} t y� `n ct a 2ir�.s 7 sf t74 4 fi.� ) 7., r 1. � r t ,",s a f d' d tJ 4 ,'x f iY; rzy. `va eat rti'F t, bs j} r,. , h- �r r c t r }. ,� 1 "• , y r v, n#r,�.�.r w.0 o'}arzM rY� t a+{ tt. x J r i A X x r T.i !i'a"1� ✓ .k X J L *r f\ t'k"rt l A 2 fr'"+ $2 ri f T r7 a 7 ?+.Y 4"tAG f#, . " ys 4 {Y, tr, ,.y Y ."Nt4 -.'r ;wit t4 k� r��t� a , . t r (5; s ,r . r . r'f"("+ . r 'n . r� rl y ty 5, .t , rq f h *6' 1 ".� lids '�4rla f '!rF'C P,j{ 4-<I 1 1' r h Yv4 4, - r 2 as j}b, grS - " :u .x�vrz 5 i t . , t tt K i. �' , r r> h wr xi•'{J;�te"'a 1 fir: t- r t 'z • x Jt.7 r s t "" t�'t ';.r5'°t�ttyµ±jfS i ;6 3"'ct;.t,} v fit >rr' r :mse" �'"t °: i /' ii : 5 is H�9 ! t #t >4 es ".,!;+t '� S ds' �. r. +� k t µ.,,�rgr `� r ,, y ` ! 1_ ' .f'' k t 7� 7 S t i't 3 6 # t i( '"`.'kti:"xA r' e i '+ t v r z J c r s i d}z a- N �` -pfix akY i c. ry�.if I I t^�,n,t.S+'W,R. }Jdt�j,,I a' !, r t� } t-'e, ra .:r It r a e,, A ',".;t ti S t.y t„t r - i .r tie","4.i''j+ n,v?1 n!„ i d ,;.' F 1 ; l S}r3r e4 .. zti.t.r< 3 rr%ii�a .. '"^ '{Y� k"rg''t�'t A, 0 C 1 i J is .. f t a 1 a �j Y' l t yt ! `t .5 t -, ,i e $ t a,tt'I.t 4}r3ara j(t,�+aire,,a L. ji td{ aV ){%t•t-� 1 , s '4. I' p.�tiz to f',s 1 ✓.,y,* l_'.'1 J sV. 4 -x t� '?`3'!.� fto '<' r 'I,r�"' ..F-+ ra. _ _ _ x •inf "r . .�', t R r.>#�i �.. ..'�.'�',.2J„�,e_.. ',Y.....'i "�, -''.F. .�. ,.I.f c'.. .1 .. .... _-'-...".-.,r.,...ti.�-••:'Si�.�....,.._,-r. .....n..-..... ..?.r',..,-n..-"f�k+ ,...v -{ trn"a..,. ;,�f. -:. r.�,.....'r 94•'��",.may.>�,,.^' .r , "Y`..:r .,^•-_.-.,.,,,..,-, TOWN OF BARNSTABLE BAR_W Md 3330 Ordinance or Regulation WARNING NOTICE s .,,.a `• Name of Offender/Manager � ,� / �1!! !.� Address of Offender ] '4 �f�.C`,i �I111QLAI)-MV/MB Reg.# ,villAge/State/Zip cc�( r I 1 f V V. � ' Bus:'ness Name Y 120(J ,am�lpm, on e Business Address •� � r, y - /f � a; S gn'ature .of Jfor'cifig Officewr`� , F will, ge/State/Zip Location of OffenseV11401A Al Enforcing Dept/Di iyoh A0 14 N } Offense ` Al � k�+k 1,"ac t s F/ll 00 P r)/U ('9- )�/ In, / n��Av OP V P/ .'/12 /2 /0 This will serve only as a warning. At/ tiifie na legal action h'as been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. t WHITE-OFFENDER- CANARY-ORDJREG,PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. J� ., _ ._.., ..,. _ "....�.,.:. ..'.-ram.r- -.-,n.,».. "S1. ^,�.rs,,...+,.t,: . '• 4�.."...+,. c.-^..-.'..,..,.�s .+..+.a.,:.,;� °ti m v..r�., TOWN OF BARNSTABLE RAR-W 3330 Ordinance or Regulation WARNING NOTICE Name,,of Offender/Manager { Ji ''� ' ' �i_ l.. +s � Address of Offender I (� ,t ��� � ,� r /,?� ,` ' > MV/MB Reg.# Villlage/State/zip ~( t l f' >` €! r'`{ tom' ` � ram' J `� f p L4 ' 1, ` Business Name am/pm;;; onn { i ~ 20_/ Business Address J' Sign"ature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Didi.sion se *Facts' ��' �,.i' ; S ' •f 1 0 3 r'�t f ,.• ,I i wt v k, .Yt �, y"/i /�4,.r". i '; 1 Facts. t }d f 1'r t i 0° ! This will serve only as a warning. At.'this'time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town ; Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. .<rr-17 -o,.a..>..Ja,ir'^TM-',.s-......-.-...r...•-........ ...... :..-r.-,.. TOWN OF BARNSTABLE BAR-W 02 3330 Ordinance or Regulation 4` WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg.# Village/State/Zip • # Business Name am/pm; on 20 Business Address r Signature of Enforcing Officer Village/State/Zip Locatibn of Offense f Enforcing Dept/Division Offense 'Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. „ WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. a Health Complaints 23-Jul-04 Time: 1:12:00 PM Date: 7/22/2004 Complaint Number: 17588 Referred To: DONNA MIORANDI Taken By: DENISE WITTER Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: UNSANITARY CONDITIONS i Business Name: Number: 198 Street:, Strawberry Hill Rd Village: CENTERVILLE Assessors Map_Parcel: Actions Taken/Results: DZM investigated. No one at home. Left my business card and a warning notice to "occupants"at the front door. There is old wood, scrap metal and some old cardboard. Shall follow up on 7/23 but gave them until 8/2/04 when I return to clean it up. Investigation Date: 7/22/2004 Investigation Time: 3:45:00 PM 1 SECTION A -A 1' 2000' 10' min. from *NOTE. ALL PIPES ARE TO BE 4' SCHEDULE 40 P.V.C. PROFILE VIEW OF LEACHING SYSTEM ALL OLMM Oro FWN THE house to septic tank VENT PIPE(O Least 24 inches ton) f/(�\`\ DatlSeUfld1 seat SHALL BE _ iY Existing Foundation Schedule PVC tr/Charwal Odor Filter ,y�L 3' of 1 SET LErt•1 FOR AT LEAST 2 Fr. 00NOt E cObF]t i Septic tank txtvere nwet be /f!' - 1/Y Washed Peaeton tdthin a in, of (wished grade or.r S"- 3/4• to 1 1/2 ' Washed Onished Stone 3- r aM IAA Bede ever s�Ptb Tank-fl810 Qad�aver D-eoz-MOD -- td100(OUT9 ?•y 061tET tY HIFi .0 I S' 0.02 3 HOLE H-20 e' to V) 29' EXISTING s-0.01 oisT.BOX S' Mmdrt.a"CoverTo I ISAS- Ow.-07.?�S EXIST,orvtr GAL s- Qol O' per root i t Y18 S• oa ti FMN FURIDATION U.1 SEPTIC TANK \\�/� ow 4' - SCH. 40 To 1.7ti' 4Q' !t 4 2 PLAN SECTION CROSS-S CTIO \ oonc ��6 4 m 1 g 4 urns a 625' . py. - to `u� SITE i 11 SYSTEM PROFILE a Nnof 3/4'-, //2' �(, ° 1' V ST'DNE UPC ER cH�1►tsERs 3 HOLE H-20 DISTRIBUTION BOX oo'"poctee siar» �(P� o > 'n 3.50' S 3.50' NOT TO SCALE Not to Scale '4 a • 2 � .2 2 23` tl 32 LOCUS MAP I - $ Effective Length e In.of 3/4'-1 1/2' 9' °o,"p°`ud .ta„e EFfet lw Vldth m° SOIL ABSORPTION SYSTEM (SAS) - CULTEC MODEL 125 (H-20 LOADING)/ SHOREY PRECASTS GENERAL NOTES (OR EQUIVALENT) and Contractor Is responsible for Digsafe notification and protection of all underground utilities and pipes. Not to Scale 2. The septic tank a d distn union box shall be set NOTE: OVERALL HEIGHT OF INFILTRATOR IS 18' /EFFECTIVE HEIGHT IS 12" level on 6" of 34 -1 tp2 stone. 3. Buckfill should be clean sand or grovel With no NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE stones over 3' In size. 4. This system is subject to inspection during installation FROM THE EXISTING CESSPOOL To BE DISPOSED by Carmen E. Shay Environmental Services, Inc. z-le•SAY.ACCM MA*Mn 5. The contractor shall install ,this system in accordance --e — OF AS PER BOARD OF HEALTH SPECIFICATIONS. with Title V of the Massachusetts state code, the approved plan ACCESS COVERS OF SEPTIC TANK TO BE and Local Regulations. `=�' �+=^ : • RAISED WITH THE APPROPRIATE RISER TO WITHIN '•� � �� ��, e' OF THE EXISTING GRADE AS PER TITLE V. 6. If, during installation the contractor encounters any EXISTING LEACH PIT TO BE PUMPED DRY & soil conditions or site conditions that are different _1 ` THE ACCESS COVERS FOR THE SEPTIC TANK, from those shown on the soil log or in our design MttET -•-� � - {1 - DISTRIBUTION BOX AND LEACHING COMPONENT REMOVED TO FACILITATE NEW SAS INSTALLATION installation must halt & immediate notification be _ ou SET DEEPER THAN 1 FOOT BELOW FINISHED made to Carmen E. Shay - Environmental Services, Inc. GRADE SHALL BE RAISED TO WITHIN 12' OF Y h GRADE .7. No vehicle or heavy machinery shall drive over the septic system unless noted as H-20 septic components. .-r �.-+,;•*x -. -- - ,-t----��'' INSTALL TtIF-T11E GAS BAFFLES OR EQUALs 8. Install Tuf-rite gas baffles or equals on all outlet tee ends. STEEL REINFORCED PRECAST CONCRETE Failed 9. All Distribution Lines shall be 4e diameter Schedule 40 NSF PVC pipes. LA VIEW Leach Pit P Pe PLAN 10. All solid piping, tees & fittings shall be 4" diameter 3-20 ItEwwr cowxs-, -" Schedule 40 NSF PVC pipes with water tight joints. OV �s,,,� 100.00' 11. Municipal Water is Connected to The Residence and Abutting -- �Q, TEST HOLE I1 i I to tv Properties Within 100 Feet. rah'deQanw •,r wrr 0� ELEV.- 97.98 p H.Ef rah. Y tt9n. -let to outlet e. .< T 0• min 1 N OUTLET Q. EXIST. 1000 gat. NOTE- Ir ' • • -r E s•-o•ram -r ♦ septic Tonle THE PROPERTY LINES ARE APPROXIMATE AND b Dy„a�1 �' �J COMPILED FROM THE SURVEY PLAN GENERATED BY t S�G BEARSE & KELLOG, SURVEYORS. OF BARNSTABLE. MA VENT PIPE ENTITLED CRAIGVILLE BEACH ESTATES, CENTERVILLE, MA' ..;. .Y ., �1' 4 SCH 40 PVC DATED APRiL 2. 1946 AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN CROSS SECTION END-SECTION IT SHOULD BE USED FOR NO PURPOSE OTHER THAN 98 ---- -------------------- - --- - -------------------- ------ ----- 98 THE SEPTIC SYSTEM INSTALLATION. 1 SE- I T Ir` 1 nnn nn 1 /1At I,_ n Crr�T n rh�LI/. - rt• _.._. - .,JE. E.�CIS, I(�.� yvy vr�Lt vl� I� lv .ELF- 1 I1.. 1/11vr\ _ __ - -r- rs EXISTING FOUNDATION _ NOT TO SCALE ZOO FRO�{f 4 BBDROObI EXIST. 0 LEGEND n HOUSE GARAGE � O i OZ n #198 ^ PERCOLATION TEST ��G Q �o4x� DDENOTES�PROPOSED SPODate of Percolation Test: JANUARY 5, 2002 _ _ ---- X 104.46 DENOTES EXISTING Test Performed By. CARMEN E. SHAY, R.S., C.S.E O 99--- ----- ------------------ --------_ ---_----- ._--- SPOT GRADE Results Witnessed By. WAIVER - 99 Excavator. Shay Environmental Services, Inc. I Percolation Rate: Less Than 2 min./Inch LOT 8 PL PROPERTY LINE # , _ a 9 890 sire FoOt f/- -- -- - PROPOSED CONTOUR 98--- ---- -------------- -------------- ---- --------------- ---- 98 Test Hole 0 97—— —— —,-97 EXISTING CONTOUR No. 1 DEPTH SOILS ELEV.; � p I a 9130o PROJECT BENCH MARK ® DEEP TEST HOLE & ,y TOP OF FOUNDATION 1 PERCOLATION TEST LOCATION Sand ELEV. 100 assumed 3 1a TR 3/2 97--- --� •---- --------- -- 80.00' -- --------------- ---- 97 0'-12• A a7.00� tp '-----' 6 FOOT STOCKADE FENCE O 0O Sandy Loom 10" 11/e REV.: 2/12/02 - Reduced to a 3 Bedroom System per BOH & Client Request. 12'- 32' Be 95.25 d /S TR'A TY•B.ER.R Y HILL R 4A D n'-1rw' 28 /` 84.00 PLOT PLAN (4o FOOT RIGHT of WAY) OF PROPOSED SEPTIC SYSTEM UPGRADE Perc #1 " � PREPARED FOR Depth to Perc: 46 to 64 Pert: Rate-<2 min.Anch MR. J 0 H N M . LI N D E Groundwater Not Observed AD Observed 0 ElevHWT i 198 STRAWBERRY HILL ROAD ADJUSTED H2O Elev. = None ' °°-A GENTERVILLE, MA design Calculation s Number of Bedrooms: 3 Exist. - Equivalent to 330 Gol./Day Garbage Grinder: No y,, H oF��q PREPARED BY: 5 aching Capacity Required: 330 Gol./Day Minimum (Title V do Barnstabl i By-Laws) OT O s �o�� E qo`„, j� � J,j' e �` A �T { eptic Tank : 2 x 330 Gal./Day - 660 USE EXIST 1,000 GAL Sept c Tank. g 1 l L ,[ Y E �J H l SOIL ABSORPTION AREA: Using percolation rate of <2 min.Anch � IRONMENTAL SERVICES, INC. i Bottom Arse: 0.74 gal/sq. ft. x 288 sq. fL - 213.12 gallons �� 1 SF►' Sidewall Area: 0.74 gal./sq. ft. x 164 sq. ft. - 121.36 gallons 0 20, 40 50 34 THATCHERS LANE ' Providing: >Q 334.48 gaoona s "ER'e EAST FALMOUTH, MA 0253fi i TEL/FAX 508-548-•0796 User: (4) HIGH CAPACITY CULTEC 125 CHAMBERS, HAVING A 1' EFFECTIVE DEPTH, (2.5' W x 6.25' L) TO BE USED WITH 3.25' OF WASHED STONE ON THE SIDES. SCA 1"=20' DRAWN BY CES DATE: JANUARY 9, 2002 3.5' OF WASHED STONE ON THE ENDS, AND 1 FOOT OF STONE BENEATH ENTIRE SAS. SCALE: 1*=20' I PROJECT#SD285 FILENAME: SD285PP.DWG SHEET 1 OF 1