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HomeMy WebLinkAbout15-17 SUNSET AVENUE - Health 15-17 SUNSET AVE. , CENTERVILLE A= _ UPC 12534 ' N%2153LQR 'gar MA4TI�Itii YN I 020210 -1�,� t _ Commonwealth of Massachusetts t. W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 15 Sunset Ave. Centerville, MA 02632 Property Address » Ram Chuttani 40 Draper Rd. 4 Owner Owner's Name r""f information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection r� iy4A Inspection results must be submitted on this form. Inspection forms may not be altered in any ma's way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information 67: on the computer, use only the tab 1. Inspector: key to move your cursor-do not Paul Martin use the return Name of Inspector key. Cape Cod Septic Services Q Company Name 350 Main St Company Address Man W.Yarmouth MA 02673 City/Town State Zip Code 508-775-2825 S15016 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 5/23/2018 Ifispector.'s Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 1, y9td vs c Commonwealth of Massachusetts d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave..Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: System is in working condition. B) System Conditionally Passes:. ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins'-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR IIII 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 r Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ _ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 16,000 gpd. For large systems, you must indicate either"yes"or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts u w Title 5 .Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components.pumped out in the previous two weeks? ❑ ® Has the system received.normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® '❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CM 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 110x4= 440gpd t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ❑ No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ® Yes ❑ No Water meter readings, if available usage last 2 ears 2016=115gpd ( Y g (gpd))' 2017=11gpd Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Unknown Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts u - d Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sunset Ave. Centerville , MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/user Date Other(describe below): General Information Pumping Records: Source of information: No Records Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: 1500 gallons How was quantity pumped determined? Truck Glass Reason for pumping: Maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owners Name information is required for every Dover MA 02030 5/16/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 16"feet Material of construction: ❑cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: +10'feet Comments (on condition of joints, venting, evidence of leakage, etc.): Line checked with sewer line and was found to be clean, properly pitched with no sign of root intrusion. Septic Tank(locate on site plan): Depth below grade: 411feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500Gal Sludge depth: 2-4" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface,Sewage Disposal System Form-Not for Voluntary Assessments a 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/20.18 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1" Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle How were dimensions determined? Estimated Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1500Gal tank in good condition. PVC tees in place and clean. Tank at normal operating level. Covers 4" below grade. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 . Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 111 of 117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,•�" 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert oil Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): H-10 DB-3 with 1 line in and 2 lines out in good condition. Tee in place on inlet. Box is clean and level with minimal solids carryover. No sign of overloading or hydraulic failure. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No* Alarms in working order: ® Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): 1000Gal Pump chamber in good condition. Pump and alarm in working condition. Chamber is clean. *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 I Commonwealth of Massachusetts W Title 5. Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 1-11'x60' ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 1-11'x60' Leach field with perforated pipe and stone. Lines were found clean and dry. Stone was probed and found dry. No sign of overloading or hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts H W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani . 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 I Commonwealth of Massachusetts -- W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40 Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 160 feet of SAS) i ® Checked with local Board of Health -explain: Engineers Letter on file ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Engineers letter on file indicates system installed per plan. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 f Commonwealth of Massachusetts W Title 5 Official Inspection Form 4 Subsurface Sewage Disposal System Form -Not for Voluntary,Assessments ^M ,•'' 15 Sunset Ave. Centerville, MA 02632 Property Address Ram Chuttani 40,Draper Rd. Owner Owner's Name information is required for every Dover MA 02030 5/16/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 • M OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building A 1 REAR SEPTIC C TANK B � 01 60' T 1 3 a PUMP CHAMBER CONCRETE RETAINING MU TANK PUMP CHAMBER D-BOX A-1=33' B-2=16' B-3=16' B-1= W&I C-2=57' C-3=45'6" 10 I • - Commonwealth Of Massachusetts Executive Office Of Environmental Affair Department Of Environmental Protection! TITLE S Official Inspection Form - Not For Voluntary Assessments; co 0u Subsurface Sewage Disposal System Form t'7 Part A , p Certification 1p Property Address:15-17 Sunset Ave.Centerville Ma.02632 Owners Name:Farrel S.Liss Owners Address: 189 Deerfield L.Hanover Ma.02339 Date of Inspection: 12/29/2005 Name of Inspector(please print)Sean M.Jones Company Name:Wm.E.Robinson Septic Service Mailing Address:P.O.Box 1089 Centerville Ma.02632 Telephone Number: 508-775-8776 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: X Passes Conditionally Passes Needs further evaluation by the Local Approving Authority Inspectors Signature Date: f 1-01-0O(, 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: ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTMUED) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owneffarrel S.Liss Date of Inspection:12/29/2005 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 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 the 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 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 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: 2 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION icoNuNum Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 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 31OCNM 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the 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 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: 3 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 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 cesspool or privy is within Zone 1 of a public well. _X_ Any portion of cesspool or privy is within 50 feet of a private water supply well. X_ Any portion of 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 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _ _X_ (Yes/No)The system fails.I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large systems: N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: 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 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 CM15.304.The system owner should contact the appropriate regional office of the Department. 4 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 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 system components pumped out in the previous two weeks? — _X Has the system received normal flows in the previous two week period? 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 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 tee,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)] 5 f - OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):-4— Number of bedrooms(actual):_4_ DESIGN flow based on 310 CMR 15.203 (for example): 110 gpd x#of bedrooms): 440GPD Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate report required] Laundry system inspected(yes or no): N/A Seasonal use:(yes or no) YES Water meter readings,if available(last 2 years usage(gpd): 2004=25,000 2005=27,000 Sump pump(yes or no): NO Last date of occupancy/use: 9/2005 COMMERCIAL/INDUSTRIAL:N/A 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 this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X_Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be Obtained from the 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: 1988 Were sewerage odors detected when arriving at the site(yes or no): NO 6 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owneffarrel S.Liss Date of Inspection:12/29/2005 BUILDING SEWER(locate on site plan) Depth below grade: 8" Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.); Joints were in good condition,no signs of leakage SEPTIC TANK:_X_(locate on site plan) Depth below grade:_6 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: 1500 GALLONS Sludge depth: 6" Distance from top of sludge to bottom of outlet tee or baffle: 3` Scum thickness: 1" Distance from top of scum to top of outlet tee or baffle:_3" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Opened covers and took measurements Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): Tank does not need to be pumped at this time,inlet and outlet tee's were intact and in good condition tank was structurally sound,liquid levels were correct at time of inspection. GREASE TRAP:_N/A_(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglass_polyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): 7 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 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 above outlet invert: OctComments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of Leakage into or out of box,etc.): Distribution box was level and water flow was equal to both outlets No sign of solids carryover,box was not leaking. PUMP CHAMBER: X_(locate on site plan) Pumps in working order(yes or no): YES Alarms in working order(yes or no): YES Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): Pump chamber was in good condition water level was at pump off level at time of inspection Pump and alarm both turned on when physically raised at time of inspection. 8 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 SOIL ABSORPTION SYSTEM(SAS): X_(locate on site plan,excavation not required) If SAS not located explain why: Type Leaching pits.Number: Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: X_leaching fields,number,dimensions: 1 Cagy 8`X55` overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Soil was drv,no sign of hydraulic failure,vegetation was normal. CESSPOOLS: N/A_(cesspools 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.): 9 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building A 1 REAR SEPTIC C TANK B � 60' 2 T 3 � 1 PUMP CHAMBER CONCRETE RETAINING WALL TANK PUMP CHAMBER D-BOX A-1=33' B-2=16' B-3=16' B-1= 10'6" C-2=57' C-3=45'6" 10 r OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15-17 Sunset Ave.Centerville Ma.02632 Owner:Farrel S.Liss Date of Inspection:12/29/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 5'Below bottom of SAS Please indicate(check)methods used to determine the high ground water elevation: _X_Obtained from system design plans on record-If checked,date of design plan reviewed: 1/1J 8/1988 Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators,installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater was determined by accessing design plan on file at Town Of Barnstable Board Of Health. 11 Town of Barnstable = BA Board of Health 1679. �� P.O. Box 534� Hyannis MA 02601 Ep�{A Office: 508-790-6265 Susan G.Rask,R.S. FAX: 508-790-6304 Ralph A.Murphy,M.D. Sumner Kaufman,M.S.P.H. February 13, 1998 W. Walter Sowydra 2 Walker Avenue Taunton, MA 02780 Dear Mr. Sowyrdra: You are granted permission to remove the deedrestriction-regarding occupancy of your duplex located at 1-5-47-Suns`et Avenue, Centerville Massachusetts' This duplex may now be occupied on a year-round basis with the following condition: The existing onsite sewage disposal system shall be inspected by a Massachusetts Department of Environmental Protection (D.E.P.) certified septic system inspector prior to expansion of use to year-round occupancy. Permission is granted because the existing septic system closely meets today's regulations, particularly in regards to setback requirements to wetlands and the groundwater table. Sincerely yours, eusan GG Rash.S. Chairman BOARD OF HEALTH TOWN OF BARNSTABLE SGR/bcs sowyrara W. Walter Sowyrda 2 Walker Avenue Taunton, MA 02780 January 17, 1998 Ms. Susan Rask Chairman, Board of Health Town of Barnstable 367 Main Street P. 0. Box 534 Hyannis, MA 02601 Dear Ms, Rack: Reference is made to letter dated February 5, 1958 setting forth conditions with regard to Title 5 septic system installed in 1988 at #15 - #17 Sunset Avenue, Centerville. I am requesting that condition number (1) as stated in the February 5, 1988 letter be removed. Condition states: "The dwelling can only be occupied on a seasonal basis from May 1 to November 31 of each year. The seasonal restriction should be recorded on the deed in the event of sale." My request is based on the following: 1. It is my opinion that since no seasonal restrictions were recorded on the deed when the septic system was designed that Down Cape Engineering; designed the system for year round occupancy. 2. Cottages #7 - #9, which abutts the beach side of my property, and Cottage #20 - #22, which abutts t#e beck side of property have had their septic systemsup graded but not to the extent of my .system. Both of these cottages are presently being occupied year round. 3. There are other cottages in the Southwinds complex that are also occupied on a year round basis® Baoed on the above reasons I request that the seasonal occupancy condition be removed for my property,-By so doing we will all be treated equally. It is my understanding that this request will be on the agenda of the February 10, 1998 meeting scheduled for 7:00 P.M. If I can be of any further assistance or you are in need of additional information, pleas do not hesitate to contact me. Thank you for your kind consideration. Ve7y00,w rs �c.� W. Walter Sowyrda 362-4541 926 main street rt 6A yarmouthport mass.02675 down cape engineering civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys January 14, 1988 site planning Board of Health Barnstable Town Hall 367 Main Street sewage system Hyannis, MA 02601 designs RE: Variance Request 15 & 17 Sunset Drive - Craigville Beach inspections DCE Job # 87-536 Members of the Board: permits On behalf of our client, Walter Sowydra, and in response to your enforcement order of August 27, 1987 we are submitting the following proposed repair/upgrade. The existing duplex was being serviced by two cesspools receiving the flow from two bedrooms each. The proposed system will disconnect the duplex from these cesspools and handle the four bedroom flow in one septic system consisting of a raised leaching field, pump system and septic tank. Due to the proximity to groundwater and the size of the lot numerous variances from state and local health regulations are required. The governing concern in designing this repair was to maintain four feet between observed groundwater and the bottom of the proposed leaching field. Due to the proximity of the site to Centerville Harbor (Nantucket Sound) it is our opinion that the U.S.G.S. groundwater adjustment is not applicable. The variances being requested are listed on sheet 2 of 2 of the submitted plans . If you have any questions or comments please do not hesitate to contact this office. Very truly yours, Stephen A. Wilson, P.E. Down Cape Engineering, Inc. SAW:tld 2SAW18 yofTeETo� TOWN OF BARNSTABLE OFFICE OF BAH MAR8. E BOARD OF HEALTH � nee. moo 2639. 367 MAIN STREET lE am HYANNIS, MASS. 02601 February 5, 1988 Mr. Walter Sowydra 939 Main Street Route 6A Yarmouthport, Ma 02675 Dear Mr. Sowydra: You are granted variances from Title 5, of the State Environmental Code, and Town of Barnstable Health ,Regulations for the upgrading of an onsite sewage disposal system at 15 and 17 Sunset Drive, Centerville, listed as Parcel 166 on Assessor's Map 226. The variances granted are: Regulation 15.02 (17) - To allow the removal of unsuitable material beneath the leaching facility and for a distance in all directions therefrom the leaching facility to be reduced to one (1) foot in lieu of 25 feet as required by Title 5. Regulation 15.02 (22) and Regulation 15.15 (6) - To allow no provision for reserve area as required by Title 5. Regulation 15.03 (7) - To allow the distance from the septic tank to the property line to be reduced to 7 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the septic tank to the outside edge of the foundation to be reduced to 8 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the pump chamber to the property line to be reduced to 5.5 feet in lieu of required 10 feet. Regulation 15.03 (7) - To allow the distance from the leaching facility to the property line to be reduced to 6 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the leaching facility to the outer edge of the foundation to be reduced to 6 feet in lieu of required 10 feet. Regulation 15.06 (17) - To allow the distance from the invert elevation of the septic tank outlet to the maximum groundwater elevation to be reduced to 8 inches in lieu of one foot as required b Title 5. q Y Mr. Walter Sowydra Re: 15 and 11'Sunset Drive Centerville Page 2. Regulation 15.03 (7) - To allow the use of an impervious barrier, to prevent breakout in lieu of additional fill as required by Title 5. To allow the onsite sewage disposal system to be located in an area where there is a three (3) foot depth of naturally occurring pervious soil below the entire area of the leaching facility above maximum groundwater elevation in lieu of the required 4 foot depth as required by Town of Barnstable Health Regulations. The following conditions apply: (1) The dwelling can only be occupied on a seasonal basis from May 1 to November 31 of each year. The seasonal restriction should be recorded on the deed in the event of sale. (2) The septic system must be installed in strict accordance to the plan. (3) The designing engineer must be onsite and supervise the construction of the sewage disposal system and certify in writing to the Board that his design has been strictly adhered to. (4) The dwelling cannot have more than four (4) bedrooms. Sewing rooms, dens, lofts, enclosed porches, study rooms, finished cellars, and similar type rooms are considered bedrooms according to the Department of Environmental Quality Engineering. (5) The onsite sewage disposal system must be pumped yearly and written certification from a licensed pumper submitted to the Board of Health. (6) The variance expires March 1, 1989. These variances are granted because the existing cesspools appear to be sitting in the groundwater. The proposed system will in all probability alleviate a source of contamination. Very truly yours, la"- Ann Jane Eshbaugh Acting Chairman Board of Health Town of Barnstable TM/bs THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH },....... .... .................................. Applirtt#inn for Disposal Works Ton'strurtion lbrutit Application is hereby made for a.Permit to Construct ( ) or Repair ( --)-an Individual Sewage Disposal System at - ` Locat Address or Lot No. Own r Address •• M Installer Address' Q7i Type of Building }' Size Lot.............:..............Sq. feet U Dwelling—No. of Bedrooms_......L ..............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e ._. a Other—Type of Buildin g ..._�p1:�:7s..__-__ No. of persons ________________________ Showers ( ) — Cafeteria ( ) QOther fixtures ------------------------•----.......----------.----- .-------------=-------..-_...----------------:..............-----... _= WW Design Flow._' .......................gallons per person per.day. Total daily flow...... ......._...............gallons. WSeptic Tank Li uid capacitA.�.0Z..gallons Length..14......_•.. Width..._11..`......._ Diameter................ Depth................ x Disposal Trench No. ........... Width.. ............ Total Length....6-- .... Total leaching area....................sq. ft. 3 Seepage Pit No..................... Diameter.................... Depth below inlet..................... Total.leaching area..................sq. ft. Z' Other Distribution box ( ) Dosing tank ( t-)' P.-1 t,O-Z-a 1 44A aPercolation Test Results Performed by----------------------------------------•---------........--.....=..... Date---------......................................... Test Pit No. 1................minutes per inch Depth of Test Pit......._............. Depth to ground water........................ 44 Test Pit No. 2...............=•minutes pe"r inch Depth of Test,Pit................... Depth to ground water........................ ............................ . ... ................................... ..... ...........•--... - ------- ODescription of Soil------------------=---------------------------------•----------...-•-----•------------------------------------------...............I........----....................... 1 V -------------------------------.....................------------------------------------------------------------- ' ..... -------- W U Nature of Repairs or Alterations—Answer when applicable...I;_,-_ ! ..... ......................... ---------------- Agreement The undersigned agrees to install the'aforedescribed Individual Sewage Disposal System in accordance with the provisions of TL ITL L 5 of the State Sanitary Code—The undersigned further a rees not to place the system in operation until a Certificate of Compliance has been issued by t bo ---- ------ ---- ---- --------- ............. 6 -- _ Date-..._... -- 1 Application Approved By................ .............................. .............. Date Application Disapproved for the following reasons-................................................................................................................. ..-•-----•----...---•--------•---•-......----•-----------------------------•------------•--------.............------...............--------------------------------------------------------------------•- Date . Permit No......... ........................ Issued.........................-•-------------------..........-•----- - > Date 362-4541 939 main street rt 6a yarmouth port mass 02675 down cape e/l fineeriag civil engineers& land surveyors structural design Arne H.Ojala P.E.,R.L.S. land court Richard R.Fairbank P.E. surveys June 13, 1988 site planning Barnstable Board of Health sewage system 367 Main Street designs Hyannis, MA 02601 RE: 17 Sunset Drive, Centerville, MA inspections Walter Sowyrda, owner Down Cape Engineering plan #87-536 permits To Whom It May Concern: On Thursday, June 9, 1988, Down Cape Engineering performed a final inspection on the septic system at 17 Sunset Avenue, Centerville, The installation complies with Down Cape Engineering Plan #87-536, dated 1/18/88, revised 2/26/88, as approved by the Barnstable Board of Health on February 5, 1988, with variances to Massachusetts Environmental Code Title V, and Barnstable Board of Health Regulations. A copy of the approval letter with conditions for installation is attached. Respectfully, Arne H. Ojala, P.E., R.L.S. inspected by : Arne H. Ojala AHO:amg cc: Walter Sowyrda Capeland Septic Installers/Roger Roberts n ��Q�oFTNtro�`� TOWN OF BARNSTABLE OFFICE OF soo a�KABIL BOARD OF HEALTH "639 367 MAIN STREET HYANNIS, MASS. 02601 February 5, 1988 Mr. Walter Sowydra 939 Main Street Route 6A Yarmouthport, Ma 02675 Dear Mr. Sowydra: You are granted variances from Title 5, of the State Environmental Code, and Town of Barnstable Health Regulations for the upgrading of an onsite sewage disposal system at 15 and 17 Sunset Drive, Centerville, listed as Parcel 166 on Assessor's Map 226. The variances granted are: Regulation 15.02 (17) - To allow the removal of unsuitable material beneath the leaching facility and for a distance in all directions therefrom the leaching facility to be reduced to one (1) foot in lieu of 25 feet as required by Title 5. Regulation 15.02 (22) and Regulation 15.15 (6) - To allow no provision for reserve area as required by Title 5. Regulation 15.03 (7) - To allow the distance from the septic tank to the property line to be reduced to 7 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the septic tank to the outside edge of the foundation to be reduced to 8 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the pump chamber to the property line to be reduced to 5.5 feet in lieu of required 10 feet. Regulation 15.03 (7) - To allow the distance from the leaching facility to the property line to be reduced to 6 feet in lieu of 10 feet as required by Title 5. Regulation 15.03 (7) - To allow the distance from the leaching facility to the outer edge of the foundation to be reduced to 6 feet in lieu of required 10 feet. Regulation 15.06 (17) - To allow the distance from the invert elevation of the septic tank outlet to the maximum groundwater elevation to be reduced to 8 inches in lieu of one foot as required by Title 5. Mr. Walter Sowydra Re: 15 and 17 Sunset(�rive Centerville Page 2. Regulation 15.03 (7) - To allow the use of an impervious barrier, to prevent breakout in lieu of additional fill as required by Title 5. To allow the onsite sewage disposal system to be located in an area where there is a three (3) foot depth of naturally occurring pervious soil below the entire area of the leaching facility above maximum groundwater elevation in lieu of the required 4 foot depth as required by Town of Barnstable Health Regulations. The following conditions apply: (1) The dwelling can only be occupied on a seasonal basis from May 1 to November 31 of each year. The seasonal restriction should be recorded on the deed in the event of sale. (2) The septic system must be installed in strict accordance to the plan. (3) The designing engineer must be onsite and supervise the construction of the sewage disposal system and certify in writing to the Board that his design has been strictly adhered to. (4) The dwelling cannot have more than four (4) bedrooms. Sewing rooms, dens, lofts, enclosed porches, study rooms, finished cellars, and similar type rooms are considered bedrooms according to the Department of Environmental Quality Engineering. (5) The onsite sewage disposal system must be pumped yearly and written certification from a licensed pumper submitted to the Board of Health. (6) The variance expires March 1, 1989. These variances are granted because the existing cesspools appear to be sitting in the groundwater. The proposed system will in all probability alleviate a source of contamination. Very truly yours, Gw.,, )a - Z.%sU Ann Jane Eshbaugh Acting Chairman Board of Health Town of Barnstable TM/bs THE COMMONWEALTH OF MASSACHUSETTS BOARD O F HEALTH -7 Appliration for Disposal Works Tono1.rur#ion jrrmit Application is hereby made for a Permit to Construct ( ) or Repair ('- • ;In Individual Sewage Disposal System at: - 1.�fi 11�7 Sc:.w T ? :� G t2 v1 v .14� ���c-V\........ ...--- ---------- ---- - --- ----- - -...-...................... Location-Address - -• or Lot No .................... .......................�—.. .---...........------.........................--. Owner Address aiq GSA ................................- �r� �: '.:.............. ::....n ............ ---•--. -.. Installer Address Type of Building Size Lot............................Sq. feet �_4 Dwelling—No. of Bedrooms............................................Expansion Attic ( ) Garbage Grinder ( ) �1.4 Other—Type T e of Building No. of persons............................ Showers YP g -----------•-=-a•---•---- P ( ) — Cafeteria ( ) PqOther fixtures .--•-•----------••-------•----------•------------------------------------•----•--------------------- Design Flow......_ .<.........................gallons per person per day. Total daily flow..... ..' .......................gallons. WSeptic Tank-L Liquid capacity's 5.0_.gallons Length-_��......... Width...2......... Diameter................ Depth................ x Disposal Trench C2 No..._:�.......... Width.............. Total Length..... ..... Total leaching area....................sq. ft. 3 Seepage Pit No--------------------- Diameter.................... Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( L.-)' 1,11,ip GVC,we -tam- 1 0-6Z - 'A 1`rr..s L40 5 hZ' 0.4 Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ fX4 Test Pit No. 2............:...minutes per inch Depth of Test Pit.................... Depth to ground water........................ Q+' --••---•----•---•-•---------•-•---•---•.............•-•--•----------------------•-----....--•----•--......................................................... QDescription of Soil........................................................................................................................................................................ W V Nature of Repairs or Alterations—Answer when applicable..-N5,"TO�41._.."T C e S v_Z Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of 1I'ALE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in p P Si ned_-----•_ d by the bo �r-d-of-health. operation until a Certificate of Compliance has been issued �---- �� Date Application Approved By................ ----- ................ - !S Date Application Disapproved for the following reasons:................................................................................................................ -•---•---••----•--------•-----------•---•--------------•---------------------------•--------•-•----•--••----------•--------------- -• ------------- -•---------------------- •--- ---- ••------- Date PermitNo........ ........................ Issued------.....---------------••-------------...........-_ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..... ?..................V�-S�-t. .......................o........................... t. (Irdifiratr of Tontplittnrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired (L-)-•'" by................. ........i--------------..._._.._........... ..._... �..--^-Installer.............................................................................................. at...............1'` { I /......., t �w T' \� e'r-Ct.7 Vl� has been installed in accordance with the provisions of TITLT,' 5 of The State Sanitary Code as described in the application for Disposal Works Construction Permit No.._..._..�0._:JUa........ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE................... I7... .�/-•--•----------....---•-----.. Inspector......................... ....... ............................................ -_..------------------------------- -- ----- ------------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF.. _,R v�-s4 --ry................................ No. .._................. FEE...........:. Disposal Works Quno#rudion firrutit Permission is hereby granted..........G v0-P .....C`K�t�17..'Z=----------------------------------------------•--•---------- to Construct ( ) or Repair (')-an Individual Sewage Disposal System, atNo.:.......M. -+... '"'v=- ''' ....................................................... Street Street as shown on the application for Disposal Works Construction Permit Dated.......................................... .......................................................... Board of Health DATE................................................................................ TOWN OF BARNSTABLE LOCATION '5;C, a &-:l-- SEWAGE VILLAGE C qP i%-t,,V\EV-e-- ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. CA PO -A N O S�Q7t FC_ _ SEPTIC TANK CAPACITY i iSd'� v D ��' �AWk: I 011 PU M0 7-Ow k n _ LEACHING FACILITY:(type) t��e�G� �i' � (size) X- + NO. OF BEDROOMS PRIVATE WELL OBI' BLIC WATF12% l� BUILDER OR OWNER �rtr.'�G'� cr3 G`d i�'C��Pl DATE PERMIT ISSUED: _�6 DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes �No . 6 � i ZONE RC. P.,c.,P t,���tiv.c, GtilrJqul f%'Yi�t - 20 �cet S dcvrno 1 is h Govcar «v� .0 car- /D'fiCt t �.• sO LJT �. r UC_Kryg r \-LQ 11 .ry.: :.„•,. / � r� 'i ,' .�'1 92' _ - - a bo, G,kJ, Et /,4 , DWI Pcat ",9 p JC'T &LC /�V ,/3 N.G.V, Z.ML1nAtG1PAL WOM 7Z - }--I-- I8O". Yyq . SIDE QI7riM�' I/¢ / UtJLE�>r� �'tl�e}`aISE i��TE(] f i f 6/ �`�' � 5, P►PE�loir.�Ts ��,t� �� r�a.�E 1�wTE2T;CrNT. a.J L 4 4 I Co, Co�.1�TRt�GTiar.1 DETa1�� 'ro F3E t�lcc�GDA, 1 Tta ' 1y G %^ tJ. c�.+NEE 1 + .b S !,n C 19 '7'L'L) /r.l '' � � �. �? `�' �1'20i.��t� i.ls.ka:.. 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