HomeMy WebLinkAbout0905 WEST MAIN STREET - Health (2) 905 WEST MAIN ST., CENTERVILLE
A= 249 019
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UPC 12534
No.2453L_R
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f No. O ! V_ Fee 60
THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes
4ptitation for Misposal 6pBtem Construction permit
Application for a Permit to Construct( ) Repair(V Upgrade( ) Abandon( ) ❑Complete System �ividual Components
Location Address or Lot No.90S &J. YnA and 5+ C�A� Owner's Name,Address,and Tel.No. �t1�Ssso- (ZJSS�I I
Assessor's Map/Parcel —Q j
Installer's Name,Address,and Tel.No. 8 B ExCra Vcx�la ^ Designer's Name,Address,and Tel.No.,DQuc F'61kzr4%1
lq Tca,Strri t.rJ FOrc54.6.1c 4-)-7- 0653 VP o.13ox 331 garw►cN% jTjy. 99y . 11 GG
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 1130 gpd Design flow provided gpd
Plan Date_,�*-19- 19 Number of sheets Z Revision Date
Title
Size of Septic Tank 1000 Type of S.A.S. N ZO ,DBO-A z - SOO
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) n ZO D,8OX- 2-c DQ !3o_1 9C
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
Compliance has been issued by this Board of Health.
Signed Date s-22-19
Application Approved by (11A, Date
Application Disapproved by Date
for the following reasons
Permit No. (d ( — �� Date Issued .2.2 `r
.. '
No. 0 ' Entered in computer:
THE COMMONWEALTH OF MASSACHUSETTS
es
PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
2pplication for Mispsal,ffipstrin Construction 3permit
Application for a Permit to Construct( ) Repair(L/Upgrade( J Abandon( ) ❑Complete System �>lividual Components
Location Address or Lot No..9os Ld, yn AM.d 5} �i Owner's Name,Address,and Tel.No. c 1 (w SS c 1
Assessor's Map/Parcel 0
Installer's Name Address,and Tel.No. Designer's Name Address and Tel.No.
' .(3 (3 i< tJccl►o� , u(,l. „�a ~l'�hcr^��(
►y"(ca5 L r�� c.r.J r�5-Idalc + 1.?• 0G53, >{-0•
Type of Building:
Dwelling No.of Bedrooms ,� Lot Size sq.ft. Garbage Grinder( )
Other Type of Building No.of Persons Showers( ) Cafeteria( )
Other Fixtures
Design Flow(min.required) 53 f7 gpd Design flow provided yR gpd
Plan Date��. 1 q. 9 Number of sheets Z Revision Date
Title f
Size of Septic Tank 42 nn Type of S.A.S. 14 0, 020� qn.?_T
Description of Soil
Nature of Repairs or Alterations(Answer when applicable) l.,f 7_n ��X . 7U07 cl�
LI
Date last inspected:
Agreement:
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of
q Compliance has been issued by this Board of Health.
Signed Date '. 22•I q
Application Approved by Date _� �C
. Application Disapproved by Date
for the following reasons
Permit No. — Date Issued ?1 ' °7
-- ---------------------------------------------------------------------------------------------------------------------------------
THE COMMONWEALTH OF MASSACHUSETTS
BARNSTABLE,MASSACHUSETTS
Certificate of Compliance
THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired Upgraded( )
Abandoned( )by
.ti
at 1��). ! )^ �.} has been constructed in accordance
with the provisions of Title 5 and the for Disposal System Construction Permit No. o 1 'dated
Installer (R iL_G—� ^��c 4,n Designer �wrE r► I, Z {�.
#bedrooms Approved design flow t gpd
The issuance of this pe it shaI not be construed as a guarantee that the system wi func'o as designed.
Date Inspector
No. i , 1 _. . Fee
THE COMMONWEALTH OF MASSACHUSETTS
PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS
Misposal 6pstem Construction 3permit
Permission is hereby granted to Construct( ) Repair(V-f Upgrade( ) Abandon( )
System located at 930,< "t,, T
� 1
and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with
Title 5 and the following local provisions or special conditions.
Provided:Construction must a completed within three years of the date of this permit.
Date S� / Approved b O n
PP Y y
r CJ
TOWN OF BARNSTABLE
LOCATION qo S tjcST MA-T rJ 5-1 SEWAGE# 2019 - 11&5
VILLAGE CLniCru:\\c. ASSESSOR'S MAP&PARCEL . yq - o\q_
INSTALLER'S NAME&PHONE NO. R
SEPTIC TANK CAPACITY /000 C,b
LEACHING FACILITY:(type) SOO god C.IC 21 (size) 13 x 2 5 x 2
NO.OF BEDROOMS 3
OWNER
PERMIT DATE: 5-2-Z- 19 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 cility) Feet
FURNISHED BY ✓r�//
Al
AZ" 2S AiAtr�w :
2. 32 -�-� REAR
A3. 23' A Q
B3 ' 39
Aq 21 ' 0-5- r
eq yZ�S
3
Town of Barnstable
0p,ME T, Regulatory Services
y� o„ Thomas F. Geiler, Director
Public Health Division BARNSTABLE.
Muss. $ tta
�AT039,lA1Qi Thomas McIZean, Director
200 Main Street, Hyannis, MA 02601 :�
0
T:.
A
Office: 508-862-4644 Fax: 505-790 6�U4
Date: S-ZQ• 19 Sewage Permit# 2019.- 185 Assessor's Map/Parcel 249- 019
Installer & Designer Certification Form
Designer: -Dq�,Qe Flobcr &A Installer: 8 4,3 EXe<LU0A;0
I
Address: P 10 Rax 331 Address: ly 'i'ca►`h r-rrM L j
Aaxw ic-k MA 026g5 F-ores4o o,lc MA Oo'C.yq
On S-22-19 QI&B Exesw0Ai0 r-, was issued a permit to install a
(date) (installer)
septic system at 9p4 Gesf MA2O ST based on a design drawn by
kaddress)
�a�e F•lcher-1ca dated -19- )9
(designer)
_ I certify that the septic system referenced above was installed substantially according to
the design, which may include minor approved changes such as lateral relocation of the
distrihution box andJor septic tank. Stripout (if required) was inspected and. the soils
were found satisfactory.
_ I certify that the septic system referenced above was installed with major changes (i.e.
greater than. 10' lateraf relocation of the SAS or any vertical relocation of any component
of the septic system) but in accordance with State & Local Regulations. Plan revision or
certified as-built by designer to follow. Stripout (if required) was inspected and the soils
were found satisfactory. ' th
DAVID
/(Installer'sSi rNITA
) l.�+NEFfT�°. J�
, -
(Designer' Signatui } (Affix Desig p Here)
PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE
OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-
BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION.
THANK-YOU.
q:\oliice fonns\designercertificauon fonn.doc
Town of Barnstable Barnstable
Inspectional Services j m'caC j
RA EilV6(ABLE,
6 9 ,��' Public Health Division W
200 Main Street, Hyannis MA 02601 2007
Office: 508-862-4644 Thomas A.McKean,CHO
FAX: 508-790-6304
CERTIFIED MAIL#7015 1730 0001 4987 7640
May 1, 2019
RUSSELL, MELISSA
905 WEST MAIN ST
CENTERVILLE, MA 02632
ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5
The septic system located at 905 West Main Street, Centerville,MA was inspected on
04/24/2019 by Brett Hickey, certified Title V Septic Inspector for the State of
Massachusetts.
The inspection of the septic system showed that the system "Fails" under the guidelines
of 1995 TITLE V (310 CMR 15.00) due to the following:
• Leaching facility with standing liquid level at or above the invert pipe (per
Town Code 360-20 h).
You are ordered to repair or replace the septic system within two (2) years from the date
you receive this notification.
Failure to repair/replace the septic system within the deadline period will result in future
enforcement action.
PER ORDER OF THE BOARD OF HEALTH
Agent of the Board of Health
Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\905 West Main Street
Centerville.doc
i
Town of Barnstable
&"NsrAmL
Regulatory Services Department
rFa raa'�
Public Health Division
200 Main Street, Hyannis MA 02601
Office: 508-862-4644 Richard Scali,Director
FAX: 508-790-6304 Thomas A.McKean,CHO
Feb 6, 2007
Rev. 5/11/16
DEADLINES TO REPAIR FAILED SYSTEMS
(Town Code §360-44 and Title V: 310 CMR 15.000)
An"x" marked in the ❑ is the failure criteria and associated repair deadline
60 DAY DEADLINE CRITERIA
❑ Discharge or ponding of effluent to the surface of the ground
❑ Pumping more than 4 times during the last year not due to clogged or obstructed
pipe.
❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool
ONE (1) YEAR DEADLINE CRITERIA
❑ Static liquid level in the distribution box above outlet invert due to an overloaded or
clogged SAS or cesspool
❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation
❑ Any portion of the cesspool within a Zone 1 to a public well
❑ Any portion of a cesspool within 50 feet of a private water supply well with no
acceptable water quality analysis. (This system passes if the water analysis
indicates the well is free from pollution).
TWO (2) YEAR DEADLINE CRITERIA
❑ Single Cesspool
❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation
of a driveway due to H-10 components, etc)
aching facility with standing liquid level at or above the invert pipe (per Town
Code §360-20 h)
OTHER
Repair deadline:
Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc
i
Commonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f '
905 West Main Street
v
Property Address TM '
Melissa Russell =t
Owner Owner's Name =
information is }
required for every Centerville Ma 02632 4-24-19 l-
page. City/Town State Zip Code Date of Inspection C i
Inspection results must be submitted on this form. Inspection forms may not be altered in any
way. Please see completeness checklist at the end of the form.
Important:When filling out forms A. Inspector Information
on the computer, Brett Hickey
use only the tab
key to move your Name of Inspector
cursor-do not B&B Excavation
use the return Company Name
key.
374 Route 130
Company Address
Sandwich Ma 02563
City/Town State Zip Code
(508)477-0653 S113747
Telephone Number License Number
B. Certification
I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5
(310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address
listed above; the information reported below is true, accurate and complete as of the time of my
inspection; and the inspection was performed based on my training and experience in the proper function
and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined
that the system:
1. ❑ Passes
2. ❑ Conditionally Passes
3. ❑ Needs Further Evaluation by the Local Approving Authority
4. ❑■ Fails
o�m Bry
Brett Hickey �. 4-24-19
�•.•Me:20tB.B6.350B05:00 LaVQ
Inspector's Signature Date
The system inspector shall submit a copy of this inspection report to the Approving Authority(Board
of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of
10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate
regional office of the DEP. The original form should be sent to the system owner and copies sent to
the buyer, if applicable, and the approving authority.
Please note: This report only describes conditions at the time of inspection and under the
conditions of use at that time.This inspection does not address how the system will perform
in the future under the same or different conditions of use.
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 1 of 18
Commonwealth of Massachusetts
- p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
u
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary
Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6.
1) System Passes:
❑ I have not found any information which indicates that any of the failure criteria described
in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are
indicated below.
Comments:
2) System Conditionally Passes:
❑ One or more system components as described in the"Conditional Pass" section need to be
replaced or repaired. The system, upon completion of the replacement or repair, as approved by
the Board of Health,will pass.
Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not
determined," please explain.
The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally
unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass
inspection if the existing tank is replaced with a complying septic tank as approved by the Board of
Health.
*A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of
Compliance indicating that the tank is less than 20 years old is available.
❑ Y ❑ N ❑ ND (Explain below):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Y Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
2) System Conditionally Passes (cont.):
❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if
pumps/alarms are repaired.
❑ Observation of sewage backup or break out or high static water level in the distribution box due
to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will
pass inspection if(with approval of Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below):
❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The
system will pass inspection if(with approval of the Board of Health):
❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below):
❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below):
3) Further Evaluation is Required by the Board of Health:
❑ Conditions exist which require further evaluation by the Board of Health in order to determine if
the system is failing to protect public health, safety or the environment.
a. System will pass unless Board of Health determines in accordance with 310 CMR
15.303(1)(b)that the system is not functioning in a manner which will protect public health,
safety and the environment:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18
c� Commonwealth of Massachusetts
- Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
❑ Cesspool or privy is within 50 feet of a surface water
❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh
b. System will fail unless the Board of Health (and Public Water Supplier, if any)
determines that the system is functioning in a manner that protects the public health,
safety and environment:
❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within
100 feet of a surface water supply or tributary to a surface water supply.
❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water
supply.
❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water
supply well.
❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or
more from a private water supply well**.
Method used to determine distance:
**This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal
coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal
to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must
be attached to this form.
c. Other:
4) System Failure Criteria Applicable to All Systems:
You must indicate"Yes" or"No"to each of the following for all inspections:
Yes No
El ❑ Backup of sewage into facility or system component due to overloaded or
clogged SAS or cesspool
❑ 0 Discharge or ponding of effluent to the surface of the ground or surface waters
due to an overloaded or clogged SAS or cesspool
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18
Commonwealth of Massachusetts
,lP Title 5 Official Inspection Form
IQSubsurface Sewage Disposal System Form Not for Voluntary Assessm Ass
essments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
4) System Failure Criteria Applicable to All Systems: (cont.)
Yes No
❑ El Static liquid level in the distribution box above outlet invert due to an overloaded
or clogged SAS or cesspool
❑ 0 Liquid depth in cesspool is less than 6"below invert or available volume is less
than '/2 day flow
❑ 0 Required pumping more than 4 times in the last year NOT due to clogged or
obstructed pipe(s). Number of times pumped:
❑ El 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.
❑ El Any portion of a cesspool or privy is within a Zone 1 of a public water supply
well.
❑ El Any portion of a cesspool or privy is within 50 feet of a private water supply well.
❑ El Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet
from a private water supply well with no acceptable water quality analysis. [This
system passes if the well water analysis, performed at a DEP certified
laboratory,for fecal coliform bacteria indicates absent and the presence
of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,
provided that no other failure criteria are triggered.A copy of the analysis
and chain of custody must be attached to this form.]
❑ ❑ The system is a cesspool serving a facility with a design flow of 2000 gpd-
10,000 gpd.
El ❑ The system fails. I have determined that one or more of the above failure
criteria exist as described in 310 CMR 15.303, therefore the system fails. The
system owner should contact the Board of Health to determine what will be
necessary to correct the failure.
5) Large Systems: To be considered a large system the system must serve a facility with a
design flow of 10,000 gpd to 15,000 gpd.
For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the
questions in Section CA.
Yes No
❑ ❑ the system is within 400 feet of a surface drinking water supply
❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply
❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection
Area—IWPA)or a mapped Zone II of a public water supply well
l5insp.doc•rev.7/26/2018 Title 5 Official Inspectlon Form:Subsurface Sewage Disposal System•Page 5 of 18
c Commonwealth of Massachusetts
�- ,p Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
C. Inspection Summary (cont.)
If you have answered"yes"to any question in Section C.5 the system is considered a significant
threat, or answered "yes"to any question in Section CA above the large system has failed.The
owner or operator of any large system considered a significant threat under Section C.5 or failed
under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner
should contact the appropriate regional office of the Department.
6. You must indicate"yes" or"no"for each of the following for all inspections:
Yes No
El ❑ Pumping information was provided by the owner, occupant, or Board of Health
❑ 0 Were any of the system components pumped out in the previous two weeks?
❑ Q Has the system received normal flows in the previous two week period?
❑ Q Have large volumes of water been introduced to the system recently or as part of
this inspection?
El ❑ Were as built plans of the system obtained and examined?(If they were not
available note as N/A)
❑ El Was the facility or dwelling inspected for signs of sewage back up?
El ❑ Was the site inspected for signs of break out?
El ❑ Were all system components, excluding the SAS, located on site?
El ❑ 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?
❑ 0 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:
❑ El Existing information. For example, a plan at the Board of Health.
O ❑ Determined in the field (if any of the failure criteria related to Part C is at issue
approximation of distance is unacceptable) [310 CMR 15.302(5)]
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18
Commonwealth of Massachusetts
r� Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information
1. Residential Flow Conditions:
No design plans 2
Number of bedrooms(design): Number of bedrooms(actual):
NA
DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):
Description:
0
Number of current residents:
Does residence have a garbage grinder? ❑ Yes [j] No
Does residence have a water treatment unit? ❑ Yes rej No
If yes, discharges to:
Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes 0 No
information in this report.)
Laundry system inspected? ❑ Yes 0 No
Seasonaluse? ❑ Yes [g No
See below
Water meter readings, if available(last 2 years usage(gpd)):
Detail:
2018- 44,000gallons 2017- 39,000gallons
Sump pump? ❑ Yes ❑■ No
4-6-19
Last date of occupancy: Date
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
u� Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
2. Commercial/Industrial Flow Conditions:
NA
Type of Establishment:
Design flow(based on 310 CMR 15.203):
Gallons per day(gpd)
Basis of design flow(seats/persons/sq.ft., etc.):
Grease trap present? ❑ Yes ❑ No
Water treatment unit present? ❑ Yes ❑ No
If yes, discharges to:
Industrial waste holding tank present? ❑ Yes ❑ No
Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No
Water meter readings, if available:
Last date of occupancy/use: Date
Other(describe below):
3. Pumping Records:
Source of information: Owner- last pumped 1 year ago
Was system pumped as part of the inspection? ❑ Yes ❑■ No
If yes, volume pumped: gallons
How was quantity pumped determined?
Reason for pumping:
t5insp.doc•rev.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18
Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
4. Type of System:
Septic tank, distribution box, soil absorption system
❑ Single cesspool
❑ Overflow cesspool
❑ Privy
❑ Shared system (yes or no) (if yes, attach previous inspection records, if any)
❑ Innovative/Alternative technology. Attach a copy of the current operation and
maintenance contract(to be obtained from system owner) and a copy of latest
inspection of the I/A system by system operator under contract
❑ Tight tank.Attach a copy of the DEP approval.
❑ Other(describe):
Approximate age of all components, date installed (if known)and source of information:
1992
Were sewage odors detected when arriving at the site? ❑ Yes ❑■ No
5. Building Sewer(locate on site plan):
31611
Depth below grade: feet
Material of construction:
❑ cast iron M 40 PVC ❑other(explain):
Town water
Distance from private water supply well or suction line: feet
Comments(on condition of joints, venting, evidence of leakage, etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18
Commonwealth of Massachusetts
�d ,lp Title 5 Official Inspection Form
la Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
6. Septic Tank(locate on site plan):
21611
Depth below grade: feet
Material of construction:
❑■ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain)
If tank is metal, list age: years
Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No
1
Dimensions: 000gallons
1491
Sludge depth:
2211
Distance from top of sludge to bottom of outlet tee or baffle
7"
Scum thickness
411
Distance from top of scum to top of outlet tee or baffle
11 if
Distance from bottom of scum to bottom of outlet tee or baffle
measured
How were dimensions determined?
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
The tank was in working order at the time of inspection. The tank is in need of pumping
at this time and should be pumped every two years for maintenance.
t5insp.doc•rev.726/2018 Title 5 Offclal Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18
Commonwealth of Massachusetts
�d Title 5 Official Inspection Form
I°I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
(t'
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
7. Grease Trap(locate on site plan):
NA
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 i
Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity,
liquid levels as related to outlet invert, evidence of leakage, etc.):
8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan):
NA
Depth below grade:
Material of construction:
❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain):
Dimensions:
Capacity:
gallons
Design Flow: gallons per day
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v 905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
8. Tight or Holding Tank(cont.)
Alarm present: ❑ Yes ❑ No
Alarm level: Alarm in working order: ❑ Yes ❑ No
Date of last pumping: Date
Comments(condition of alarm and float switches, etc.):
*Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No
9. Distribution Box(if present must be opened) (locate on site plan):
0"
Depth of liquid level above outlet invert
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any
evidence of leakage into or out of box, etc.):
The d-box was in poor condition at the time of inspection.
t5insp.doc•rev.7/26/2018 Title 5 Offidal Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18
Commonwealth of Massachusetts
�a Title 5 Official Inspection Form
�e
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
10. Pump Chamber(locate on site plan):
Pumps in working order: ❑ Yes ❑ No*
Alarms in working order: ❑ Yes ❑ No*
Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.):
NA
* If pumps or alarms are not in working order, system is a conditional pass.
11. Soil Absorption System (SAS) (locate on site plan, excavation not required):
If SAS not located, explain why:
Type:
El leaching pits number: (1) 6'x6' pit
❑ leaching chambers number:
❑ leaching galleries number:
❑ leaching trenches number, length:
❑ leaching fields number, dimensions:
❑ overflow cesspool number:
❑ innovative/alternative system
Type/name of technology:
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18
c Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
V
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
11. Soil Absorption System (SAS) (cont.)
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of
vegetation, etc.):
The SAS was in hydraulic failure at the time of inspection. Pit was full to inlet invert
when viewed.
12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan):
NA
Number and configuration
Depth—top of liquid to inlet invert
Depth of solids layer
Depth of scum layer
Dimensions of cesspool
Materials of construction
Indication of groundwater inflow ❑ Yes ❑ No
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18
c Commonwealth of Massachusetts
1 p Title 5 Official Inspection Form
( Ial Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
13. Privy(locate on site plan):
NA
Materials of construction:
Dimensions
Depth of solids
Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,
etc.):
t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18
Commonwealth of Massachusetts
�n Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
u—
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system, including ties to at least two permanent reference
landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters
the building. Check one of the boxes below:
❑■ hand-sketch in the area below
❑ drawing attached separately
iurriv;ur enxrta;;suLt
r. ' !2..
vex%AiyE
ASSE5SbR'S
NSTALLER'SAAHE&PHONE:NO.
SfiPTIC:TANKCAPA 17Y
1EAC1TNG"PXC114 fY;ltype)" ICC�Gf. txzel __
.t7P E RCYJlIS PRi ATE'WELt.O UEl.iti;. A7ER
BUIT DER bR OWtiER y _'G �ZG w
DATE ER1tlT l8$UE.D
DATE-COMPLikNCE ISSUED: _ �.. z
YAMANCE GRANTED• Yes : o I b,t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18
f
c Commonwealth of Massachusetts
�o Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
v 905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
D. System Information (cont.)
15. Site Exam:
❑■ Check Slope
❑■ Surface water
❑■ Check cellar
❑E Shallow wells
Estimated depth to high ground water: No GW @ 15'
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
El 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:
A large drop off abutting the property >15 below height of system shows the SAS
to be above high ground water.
Before filing this Inspection Report, please see Report Completeness Checklist on next page.
t5insp.doc•rev.7262018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18
c� Commonwealth of Massachusetts
�s Title 5 Official Inspection Form
Subsurface Sewage Disposal System Form -Not for Voluntary Assessments
905 West Main Street
Property Address
Melissa Russell
Owner Owner's Name
information is Centerville Ma 02632 4-24-19
required for every
page. City/Town State Zip Code Date of Inspection
E. Report Completeness Checklist
Complete all applicable sections of this form inclusive of:
A. Inspector Information: Complete all fields in this section.
QQ B. Certification: Signed & Dated and 1, 2, 3, or 4 checked
❑■ C. Inspection Summary:
1, 2, 3, or 5 completed as appropriate
4(Failure Criteria)and 6(Checklist)completed
❑■ D. System Information:
For 8: Tight/Holding Tank—Pumping contract attached
For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached
For 15: Explanation of estimated depth to high groundwater included
t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18
;
YOU WISH TO OPEN A► BUSINESS?
For Your Information: Business certificates (cost$40.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME in town (which
you must do by M.G.L.-it does not give you permission to operate.] Business Certificates are available at the Town Clarks Office, 1"FL., 367
Main Street, Hyannis, MA 02601 [Town Hall)
y, ; ! DATE: 311 T I?- Fill in please:
APPLICANT'S YOUR NAME/S: SSGL P�SS•�!
BUSINESS YOUR HOME ADDRESS: Gl O IMCI.1✓1 S �P
f r:Y: ( • GSM �—�r- �/l l� 01 bZ_t o 3
_ TELEPHONE # Home Telephone:Number E5 LI _.
NAME OF CORPORATION: k
cjzl
NAME OF NEW BUSINESS _c, cu)p��co r Qti, r TYPE OF BUSINESS
IS THIS A HOME OCCUPATION? YES NO
ADDRESS OF BUSINESS Q ; IIV. Mau R r AP/PARCEL NUMBER (Assessing)
When--starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth
-Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1: BUILDING COMMISSIONER'S OFFICE
This individual has been informed of any permit requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
2. BOARD OF HEALTH
This individual he inform d per it egc7i ants that pertain to this type of business.
thorized SigK<re** `
COMMENTS: — _ MUST wOMp
Ly
nAZJiKUUUS MATERIALS -;n A-N,
3. CONSUMER AFFAIRS (LICENSING,AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature** .
COMMENTS:
i
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DATt°5/15/01 ----_
PROPERTY ADDRESS:90.E West Main_5t:LPe. ,__
!yannis.Masss,__.......
02601
-- --------------------
On the above dote, I Inspected the aeptlo ,systoih at the above address.
This system consists of the followings
1 . 1 -1000 gallon septic tank.
2. 1 -Distribution box.
3 . 1 -1000 gallon precast leaching pit.
eased on my Inspectlon, I cortlfy the following oondltlona;
4 . This is a title five septic system. ( 78 Code )
5. The septic system is in proper working order
at the present time.
6. Maintenace pumped the system at time
of inspection.
$I Q N AT U R S t,./ ....L:.eG� .
N a m e:_a L .U S St m tt.9.C...).Jj
Company; Jo•.�h_P _ N•eomb�r-b Son , Inc
Address;_ Box_66_ ......
__CenterY111eL Nay-02632-0066
Phone•___ 508_775_»�8 ,
THIS CIRTIFICATION OOES NOT CONSTITVTC A OVARANTY OR WARRANTY
•
JOSEPH P. MACOMBER & SON, INC,
T4nks•C��>ipool+•l oachfl#ld�
Pumped t. Initsiled
Town Sewer Connevtlons
P.O. Box 6�75,J33 te�77, MA 2632-0066
s;
�Y
I
COMMONWEALTH OF MASSACHUSETTS
r EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
i
TITLE 5
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM
PART A
CERTIFICATION
Property Address: 905 West Main S re t
Hvannia Maas '
Owner's Name: v McNamara
Owner's Address:37 Whi tmAr- a�---
Date of Inspection:
Name of inspector: (please print) seph P mucomher Jr.
Company Name:J D Mannmhar i son Inc.
Mailing Address: Rnx 66
rAnt-arvi 1 IQ tut^
Telephone Number: 508-775-3338_
CERTIFICATION STATEMENT
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 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�s ction 15.340 of Title 5(310 CMR 15.000). The system:
!/ Passes
_ Conditionally Passes
Needs Further Evaluation by the Local Approving Authority
Fails
Inspector's Signature: Date: cll
The system inspector shall s bmit a copy of this inspectio 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.
Title 5 Inspection Form 6/15/2000 page I
Page 2 of I I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
Property Address: 905 West Main Street
Hyannis, ass.
Owner: K. McNamara
Date of Inspection: 5 1 5 01
Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D
A System Passes:
I have not found y information which indicates that any of the failure criteria described in 310 CMR
15.303 or in 310 C 15.304 exist. Any failure criteria not evaluated are indicated below.
Comments:
The septic system is in proper working order
at the present time.
B. System Conditionally Passes:
One or more system components as described in the"Conditional Pass"section need to be replaced or
repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health, will pass.
Answer yes, no or not determined (Y,N,ND) in the for the following statements. If"not determined"please
explain.
,d)Q 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 task 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:
�tQ 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
` Page 3 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 905 West Main Street
Hyannis,Mass.
Owner: K. McNamara
Date of Inspection: 5/1 5/01
C. Further Evaluation is Required by the Board of Health:
-_4& 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:
A.V 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 I of a public water supply.
,f26The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well.
&D The system has a septic tank and SAS and the SAS is less than 100 feet¢ut 50 feet or more from a
private water supple well". Method used to determine distance /�fs1lj9 t,
"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
i
Page 4 of 1 1 '
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address: 905 West Main Street
yannis,Mass.
Owner:K. McNamara
Date of Inspection: 5 1 5 01
D. System Failure Criteria applicable to all systems:
You must indicate"yes"or"no"to each of the following for all inspections:
Yes No
ackup 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 14A100
_ Liquid depth incesspoel is less than 6"below invert or available volume is less than 'IA day flow
fVRequired pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number
of times pumped—I—.
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.
�Kny 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, n
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 cop},of the analysis must be attached to this forma
/U (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 X
_ Zsystem is within 400 feet of a surface drinking water supply
heystem is within 200 feet of a tributary to a surface drinking water supply
the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped
Zone Il of a public water supply well
If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered
"yes" in Section D above the large system has failed. The owner or operator of any large system considered a
significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR
15.304. The system owner should contact the appropriate regional office of the Department.
4
Page 5 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Property Address:905 West Main Street
Hyannis,Mass,
Owner: K. McNamara
Date of Inspection: 5/1 5/01
Check if the following have been done. You must indicate"yes"or"no"as to each of the following:
Yes No
7Pumping 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?
YHave 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 avai.lable note as N/A)
4Z_ Was the facility or dwelling inspected for signs of sewage back up?
Was the site inspected for signs of break out?
Were all system componentsA41uding 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 ?
!/eb- 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
_ Existing information. For example,a plan at the Board of Health.
Determined in the field(if'any of the failure criteria related to Part C is at issue approximation of distance
is unacceptable) (310 CMR 15.302(3)(b))
5
Page 6 of 1 I
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address:905 West Main Street
Hyannis,Mass.
Owner: Kerry McNamara
Date of Inspection:5 15 01
FLOW CONDITIONS
RESIDENTIAL
Number of bedrooms(design):_�_ Number of.bedrooms(actual): It
DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms). X ) z
Number of current residents: X
Does residence have a garbage grinder(yes or no):
Is laundry on a separate sewage system(yes or no):AO [if yes separate inspection required)
Laundry system inspected(yes or no): S►
Seasonal use: (yes no):
Water meter readings, if available(last 2 years usage(gpd)):
Sump pump(yes or no): _ "MV$ 0916V
Last date of occupancy: f }'
COMMERCIALJINDUSTRIAL
Type of establishment: ,yjp
Design flow(based on 310 CMR 15.203): AIA gpd
Basis of design flow(seats/persons/sgft,etc.): AM
Grease trap present(yes or no): ,VA
Industrial waste holding tank present(yes or no):Ajd
Non-sanitary waste discharged to the Title 5 system(yes or no):Ag
Water meter readings, if available: AN
Last date of occupancy/use:A—
OTHER(describe): a
GENERAL INFORMATION
Pumping Records ./
Source of information:
Was system pumped as part of the inspection(yes or no):
If yes, volume pumped: b gallons--How was rntltX�mped et ermined.)
Reason for pumping: y �a� yC. / yes
TYPPOF SYSTEM
eptic tank,distribution box,soil absorption system
Single cesspool
Overflow cesspool
Privy
Ze 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 4,&�P Attach a copy of the DEP approval
/( Other(describe): Aw
Approximate age of co vents, date in to ed(if known)and source of information:
Were sewage odors detected when arriving at the site(yes or no):-UB
6
Page 7 of 1 I
OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 905 West Main Street
yannis, ass.
Owner: Kerry McNamara
Date of Inspection: 5 1 5 01
BUILDING SEWER (locate on site plan)
Depth below grade:
Materials of construction: cast 'von 40 PVC.✓Dother(explain): �tJ11
Distance from private water supply well or suction line: /I`f
Comments(on condition ofjoints, venting, evidence of leakage etc.):
Joints appear tight, No evidence o leakage.System is
/06pqRkjA,,xy vented through a house ven
SEPTIC TANK: (locate on site plan)
Depth below glade:
Material of construction: concrete ggmetal lfiberglass&/&olyethylene
420other(explain) i(J
If tank is metal list age:to Is age confirmed by a Certificate of Compliance (yes or no). ln (attach a copy of
ime D
�mensions:
Sludee depth.
Distance from top of sl dge to bonom of outlet tee or baffle: ) _
Scum thickness:
Distance from top of scum to top of outlet tee or baffle: D
Distance from bonom of scum to bon of outlet tee or baffle:
Ho" Acre dimensions determined: j47 irls�ecT�
Comments (on pumping recommendations, inlet and outlet tee or baffle condition structural integrity, liquid levels
as related to outlet inven, evidence of leakage,etc.):
. Pump the septic tank ever 2-3 years.Inlet & outlet tees
are in place.The tank is structurally sound and shows no
evidence of leakage.
GREASE TRAP(locate on site plan)
Depth below grade: 40
Material of construct ion:,ei concretedAmeta14?AfiberglassAI&o lye thylene,{,�4other
(explain): Aw
Dimensions:
Scum thickness:
Distance trom top of scum to top of outlet tee or baffle:
Distance from bosom of scum to bonom of outlet tee or baffle: --
Date of last pumping: A)j9
Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels
as related to outlet inven, evidence of leakage,etc.):
Grease trap is not present.
I
7
r
' Page 8 of I 1
OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address: 905 West Main Street
Hyannis,Mass.
Owner:KPrry MrNamara
Date of Inspection: c;f 1 r;101
TIGHT or HOLDING TANK,((tank must be pumped at time of inspection)(locate on site plan)
Depth below grade:
Material of construction:A&concrete Ametal& fiberglass polyethylene d&l_other(explain):
AJO
Dimensions:
Capacity: gallons
Desien Flow: gallons/day
Alarm present(yes or no):
Alarm level: a)J¢ Alarm in working order(yes or no):
Date of last pumping: —44
Comments(condition of alarm and float switches,etc.):
Tight or holding tanks are not present.
DISTRIBUTION BOX: Zif present must be opened)(locate on site plan)
Depth of liquid level above outlet invert: J&
Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of
leakage into or out of box, etc.):
Distribution box has one lateral.No evidence of solids
carrv_ over_No evidence of 1 akaae into or out of the box
PUMP CHAMBEM1 C(locate on site plan)
Pumps in working order(yes or no): 40-4
Alarms in working order(yes or no):
Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.):
Pump chamber is not present
8
' Page 9 of I I '
OFFICIAL INSPECTION FORM —NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Add ress905 West Main Street
Hyannis,Mass.
Owner: Kerry McNamara
Date of inspection: 5 15 01
SOIL ABSORPTION SYSTEM (SAS): 2(locate on site plan,excavation not required)
If SAS not located explain why:
Located;The septic system is in proper working
order at the present time.
Typ
leaching pits. number:
_42Q leaching chambers,number: O
.A&leaching galleries,number: O
leaching trenches,number, length: 0
Vd leaching fields,number,dimensions:0
A.)6overflow cesspool, number: -a—
�---
,ja innovative/alternative system Type/name of technology:;/T,/c FIL! a
Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,
etc.):
Loamy sand to boney fine sand.No signs of hydraulic failure or
ponding.Soils are dry.Vegetation is normal.
CESSPOOLS1,&X(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 laver:
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.):
Cesspools are not present.
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.):
Privy is not present.
9
Page 10 of 1 1 '
OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(continued)
Property Address:905 West Main Street
Hyannis,Mass.
Owner: Kerry McNamara
Date of inspection: 5/15/01
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.
0
q05 k7csf N1aM S+
w�IP�ant
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10
' Page I I of I I
OFFICIAL INSPECTION FORM — NOT FOR VOLUNTARY ASSESSMENTS
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Propem- Address: 905 West Main Street
yannis, ass.
Owoer: Kerry McNamara
Date of lospectioo:5 1 5?01
SITE EXAM
Slope
Surface water
Check cellar
Shallow wells
Estimated depth to ground water 0461 feel
Please indicate (check)all methods used to determine the high ground water elevation:
Ob aind fr �(abuning
desi lans on record • If checked,date of design plan reviewed:
g;Checkeed
bserved siteroe bservation h le within ISO feet of AS)
with local Board of Health explain:Pnf-T ASi/',l�+" �it'i4vl�
t� Checked with local excavators, installers.(anach documentation)
Accessed USGS database-explain:
You must describe how you established the high ground water elevation:
Used water contours map.
Gah_rety & Miller Model
12.41F/94
II
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'1'UHN OF Barnstable WARD OF HEALTH
-^^ •'-. .-,9U119URFACF 9FYA(IP^I)( f'U9AL�9Y�STF.M IN��CPION FORM -' PART D •- CERTIFICATION
-TY/C OA PAINT C1.6AALY- 1
P110PERTY INSPECTED
STREET ADDRESS 905 West Main Street Hvannis ,Mac;c; _
ASSESSORS HAP , DLOCK AND PARCEL I
OWNER' s NAME Kerry McNbmara
i
PART D - CPsRTIFICA rIOH
NAME OF INSPECTOR Joseph P. Macomber Jr,
COMPANY NAME, Joseph P . Macomber &r'Son, Inc.
COMPANY ADDRESS Box .66 _ _ Centerville MA. 02632-0066
Str9gt To►m or Clty $tat• r P
COMPANY TELEPHONE ( 508 ) 775 3338 FAX (508 790 -1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa`1 system nt
Or'ecommendat' lons
his nddress and that the information reported is true , accurate , and
omplete ns of the time of .-inspection . The inspection was performed and any
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�/System PASSED '
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
healLh or the environment as defined in 310 CHR 16 . 303 . Any failure
criteria not evalunted are as stated in the FAILURE CRITERIA section of
this form ,
System FAILED=
The Inspection which I have con Ttcted has found that -the system fails to
protect the j)ublic henith and the environment in accordance with Title
5 , 110 CHR 16 , 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this inspection form .
Inspector Signature Date r— d
ne copy of this certification must be provided to the OWNER, the BUYER
t where appl loable ) and the 130ARD Oil HEALTJI,
• If the inspection FAILED , thb owner orw�0perator shall upgrade ' the system
within one year of the date of the inspection , unless allowed or required
otherwise as provided in 3.10 chin 16 , 306 ,
partd , doc
a
.r�
Town of Barnstable
Department of Health, Safety, and Environmental Services
lAR1VSPABi.E.
MASS. Public Health Division
P.O. Box 534, Hyannis MA 02601
Office: 508-862-4644 Thomas McKean,RS,CHO
FAX: 508-790-6304 Director of Public Health
January 3, 2000
Rosalie A. Melody
P.O. Box 402
Hyannisport, MA 02647
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE II MIlVIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE BOARD OF HEAL NUISANCE
CONTROL REGULATION NUMBER ONE
The property owned by you located at 905 West Main Street, Centerville was inspected
on December 28, 1999, by Jerry Dunning, Health Inspector for the Town of Barnstable,
because of a complaint. The following violations of the Nuisance Control Regulation
Number One Regulation and the Sanitary Code II were observed:
410.601: Dumpster at the rear of house has no cover. There is also a large amount
of brush on the ground beside the house.
You are directed to correct violations within five (5) days of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven(7) days after the date order is received. However, this violation must
be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than $500. Each separate day's failure to comply with an order shall constitute a separate
violation. You are also subject to non criminal citations of$40.00 for the first violation
and $15.00 for each additional violation. Tickets will be issued daily until the violations
are corrected.
PER ORDER OF THE BOARD OF HEALTH
�om A. McKean
Director of Public Health
melody/wp/cos
fG j ,� c, Q
NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.00, STATE SANITARY
CODE II. MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION
AND THE TOWN OF BARNSTABLE BOARD OF HEALTH NUISANCE
CONTROL REGULATION NUMBER ONE
The property owned by you located at -5 �A0--
r was inspected on j�, g - 1999, by
Health Inspector for the Town of Barnstable, b ause of a complaint. The following
violations of the Nuisance Control Regulation Number One Regulation and the
Sanitary Code II were observed: q15 . f�a r
You are directed to correct violations within
of receipt of this notice.
You may request a hearing if written petition requesting same is received by the Board of
Health within seven(7) days after the date order is received. However, this violation must
be corrected regardless of any request for a hearing.
Please be advised that failure to comply with an order could result in a fine of not more
than S500. Each separate day's failure to comply with an order shall constitute a separate
violation.
You are also subject to non criminal citations of S40.00 for the first violation and 515.00
for each additional violation. Tickets will be issued daily until the violations are corrected.
PER ORDER OF THE BOARD OF HEALTH
Thomas A. McKean
Director of Public Health
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LOCATI0M. // ��� "J — SEWAGE #
VII.I,AGE �' A��" ASSESSOR' MAP & LOT
;INSTALL.ER'S NAME& PHONE NO.
SEPTIC TANK CAPACITY
�,
LEACHII�IG FACILITY: (type) (size)
6X�d
NO.OF BEDROOMS
BUILDER
ER OR OWNER
PERMITDATE: COMPLLANCE 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 weUs exist
on site or within 200 fat of leaching facility) Feet
Edge of Wetland and Lca 'ng Fac'lity(If any wetlands exist Feet
within 300 feet 1 , n liry)
Furnished by L�'
IDS �J e&+- ova�n 9+ aay)
wf(trt
G-ars�e _
Rear
LN
D ATE: .10/10- 98 .
PROPERTY ADDRESS: •1905 -We-.t Main Street
Centerville,Mass. - � P
'02632 • p�
CT 0 199'8
TOWN OF BARN'TABLE
HEALTH DTF
On the above date, I Inspected the septic system at tf a above addrea�� `
This system conslsts of the following: �,
1 . 1 -1000 gallon septic tank.
2 . 1 -1 -Distribution box.
3 . 1 -1000 gallon precast leaching pit.
Saaed bn my Invnectlon, I cer-tify the following conditions:
4 . This is a•• title' five septic system. ( "78^Code )
5 . The septic system 'is in -proper . working order
at the present time.
6 . Pumped septic tank at time of inspection. "
81GNAT.UF?7
Mama J . P , M'acomber Jr,. .% • i ' . .
-------.----- -------
Company:_J• P_Macogber. &— Son_Tnc
_
__Cente_rvilLe jtgjj,;_02632
Phone:
__:Sa8..Z7.5._.3338_______ --
THIS CERTIFICATION DOES NOT CONSTITUTE A GUARANTY OR WARRANTY
SOSEPH P. MAXMSER & SON, INC,
Tinki-Cs
. PUmprd I' In$ III&d
Town Sewer Connections
P.O. Box 66' Centerville, MA 02632.0066
77.5-3338 775- 412
f
COMMONWEALTH OF MASSACHUSETTS
EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ONE WINTER STREET, BOSTON, MA 02108 611.292•5500
r
WILLIAM F.WELD TRUDY CO
Govcmor Sccrct
ARGEO PAUL CELLUCCI DAVID B.STRU
Lt.Govcmor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissio
PART A
CERTIFICATION
Property Address:905 West Main Street Centervilledress of Owner:Box 402
Date of Inspection:, 0/20�98 Mass, (If different) Hyannisport,Mass
r:.Name of Inspecto ng,. 4 P mA-c=ber Jr. 02647
I am a DEP approved syste inspector ursuant to Section 15.340 of Title 5 (310 CMR 15.000)
Company Name: J.Y.Macom�er & Spon Inc.
Mailing Address: Eox bb Centerviile,Mass.--0-2632
Telephone Number: _ 508-775-3338 ^�
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 inspection. The inspection was performed based on my training and experience in the proper function and
maintenance of on-site sewage disposal systems. The system:
,Passes
Conditionally Passes
Needs Further Evaluation By the Local Approving Authority
Fails
Inspector's Signature: Date:
The System Inspecto shall submit a copy of this inspection report to the Approving Authority within thirty (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 Department of Environmental Protection. The original should be sent to the system owrX
and copies sent to the buyer, if applicable, and the approving authoriry.
INSPECTION SUMMARY: Check A, B, C, or D:
p A) SYSTEM PASSES:
SI have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303.
Any failure criteria not evaluated are indicated below.
COMMENTS:
BI SYSTEM CONDITIONALLY PASSES:
e_ One or more system components as.described in the "Conditional Pass" section need to be replaced or repaired. The system, upo
completion of the replacement or repair, as approved by the Board of Health, will pass.
Indicate yes no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If`not determined", explain why not.
The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of
Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; o
the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank
failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank
as approved by the Board of Health.
(roviaed 04/25/117) Y&y• 1 of 10
DEP on the Word Wide Web: hnp:/rwww.mapnet.state.ma.us/dep
Printed on RecyGed Paper
r
SUBSURFACE
SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddress: 905 West Main Street Centerville,Mass.
owner: Rosalie Melody. .
Ogle of Inspection: 1 0/2 0/9 8
61 SYSTEM CONDITIONALLY PASSES (continued)
Sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed
pipe($) or due to a broken, tented or uneven distribution box. The system will pass Inspection if(with approval of the
Board of Health). Describe observations:
broken pipe(s) are replaced
obstruction is removed
distribution box is levelled or replaced
The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pus
inspection if(with approval of the Board of Health):
broken pipets) are replaced
obstruction is removed,
Cl FURTHER EVALUATION IS REQUIRED BY THE BOARD Of HEALTH:
Nll Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect t.
public health, safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER
WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT(
Cesspool or privy is within 50 ("t 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 APPROPRIATE) DETERMINES TH.
THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE
ENVIRONMENT:
4(� The system has a septic tank and soil absorption system (LQ and the SAS is within 100 feet to a surface water supply
tributary to a surface water supply.
The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well.
The system has a septic tank and soil absorption system and the SAS Is within 50 feet of a private water supply well.
The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a
private water supply well, unless a well water analysis for eoliform bacteria and volatile organic compounds indicates th
the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nivogen is equal to r
less than 5 ppm. Method used to determine distance _(approximation not valid).
7) OTHER
�(1/9IVA
tr.vt..a 0�/7f/s7) r6ge 2 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION (continued)
PropertyAddress: 905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inapcction: 1 0/20/98
DI SYSTEM FAILS:
You must indicate ei;i.er 'Yes' or 'No- as to each of the following:
I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis
(or this determination is identified below. The Board of Health should be contacted to determine what will be necessary to corre,
the failure.
Yes No
Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool.
X1 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 t e cli$y jbution box above outlet Invert due to an overloaded or clogged S/S or cesspool.
Liquid depth in Ea44pQ01 is less than V below invert or available volume is less than 1/2 day flow.
f� Required pumping more than a times in the last year NQT due to clogged or obstruned pipets).
Number of times pumped ®.
YAny portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation.
Any portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply.
Any ponion of a cesspool or privy is within a Zone I 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 n
acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis fa
coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen.
E) LARGE SYSTEM FAILS:
You must indicate either 'Yes' or 'No' as to each of the following:
The following criteria apply to large systems in addition to the criteria above:
The system serves a facility with a design flow of 10,000 gpd or greater (Large System) and the system is a significant threat to
public health and safety and the environment because one or more of the following conditions exist:
Yes No
the system is within 400 feet of a surface drinking water supply
/yff the system is within 200 feet of a tributary to a surface drinking water supply
dff 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)
The owner or operator of any such system shall bring the system and facility Into full compliance with the groundwater treatment program
requirements of 314 CMR 5.00 and 6.00. Please.consult the local regional office of the Department for funher information.
ls•vl••d 0//a3/)7) Y•0• ) of 10
a 1
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
PropertyAddress: 905 West Main Street Centerville,Mass .
owner: Rosalie Melody
Date of Inspection: 1 0/2 0/9 8
Check if the following have been done: You must indicate either 'Yes' or 'No' as to each of the following:
Yes No/ '
Pumping information was provided by the owner, occupant, or Board of Health.
_ Y None of the system components have been pumped for at least two weeks and the system has been receiving normal
now rates during that period. Large volumes of water have not been Introduced into the system recently or
/ as pan of this inspection.
✓ 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 system does not receive non-sanitary or Industrial waste flow.
_ The site was inspected for signs of breakout.
_ All system components, uding the Soil Absorption System, have been located on the site.
_ 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.
— The size and location of the Soil Absorption System on the site has been determined based on:
The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance o
Sub-Surface Disposal System.
Existing information. Ex. Plan at B.O.H.
_ Determined in the field (if any of the failure criteria related to Pan C is at issue, approximation of distance is
unacceptable) (15.301(3)(b)j
(r.vs..a 04/7s/)7) ).y• l of 10
SUBSURFACE SEWAGE DISPOSAL,SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Property Address: 905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inspection: 10/2 0/9 8
FLOW CONDITIONS
RESIDENTIAL:
Design flow: ° .p.dd../bedroom for S.A.S.
Number of bedrooms:
Number of current residents:
Garbage grinder (yes or no):_6
Laundry connected to system (yes or no):kS
Seasonal use (yes or no):4 n
Water meter readings, if available (last two (2)year usage (gpd): G9 — �Sump Pump (yes or no):� `c° Odd G .-/y i9a. i'T
Last date of occupancy:"A)
COMMERCIAUINDUSTRIAL•
Type of establishment:
Design flow: &A gallons/day
Grease trap present: (yes or no)Ald
Industrial Waste Holding Tank present: (yes or no)_dA4
Non-sanitary waste discharged to the Title S system: (yes or no)-AM4
Water meter readings, if available: A1t�
A26
Last date of occupancy:_ _
OTHER: (Describe) /Ili
Last date of occupancy:
GENERAL INFORMATION
PUMPING R ORDS and so ctoifor tion,
System p ped as pan of inspection: (yes or no)
If yes, volume pumped: D allons y
Reason for pumping: _ ii.e'f -( Qdd A', *e /N T4�, Trd�C,
TYPE OF SYSTEM
_Septic tank/distribution box/soil absorption system
Single cesspool
Overflow cesspool
�0 Privy
Shared system (yes or no) (if yes, attach previous inspection records, if any)
VA Technology etc. Copy of up to date contract?
Other 10
APPROXIMATE AGE of all components, date installed (if known) and source of information:
Sewage odors detected when arriving at the site: (yes or no),Q
(revised 04/25/M Page 5 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address:905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inspection: 1 0/2 0/9 8
BUILDING SEWER:
(Locate on site plan)
Depth below grade:�-c�vJ
Material of construction: cast iron Z40 PVC_other (explain)
Distance from,private water supply well or suction line IV Lt
Diameter
Comments: (condition of joints, venting, evidence of leakage, etc.)
Joints appear tight: No evidence of leakage
Rystpm i s vpntRd thrcnigh the hnnGp vAni-
SEPTIC TANK:.&z)9* D s
(locate on site plan)
,f
Depth below grade:
Material of construction: concrete _metal _Fiberglass _Polyethylene _other(explain)
If tank is metal, list age Is age confirmed by Certificate of Complianceo (Yes/No)
Dimensions:_ ���//�t6it� 'elollyda 6i/21��t �J
Sludge depth:_
Distance from top of sludge to bottom of outlet tee or baffle_
Scum thickness: p a
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom of scum to bottM of outl t tee or baffle:
How dimensions were determined:
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, etc.) Pump the tank every 2-3 years;Inlet & outlet tees
are in place;The tank is structurally sound and shows no
eyidencp of leakage_
GREASE TRAP:;
(locate-on site plan)
Depth below grader
Material of construction;lJrconcrete4l�2meta4,)&Fiberglass,VAPolyethylene other(explain)
Dimensions:
Scum thickness: A_
Distance from top of scum to top of outlet tee or baffle:
Distance from bottom o�f9s.,;um to bottom of outlet tee or baffler
4
Date of last pumping:
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, etc.)
Grease trap is not present.
I
(revised 04/25/97) Page 6 of 10
V
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inspection:1 0/2 0/9 8
TIGHT OR HOLDING TANK: MA, (Tank must be pumped prior to, or at time, of inspection)
(locate on site plan)
Depth below grade: Allf
Material of construction:AAconcrete dAmetal A1.4 Fiberglass,vLPolyethyleneV4 other(explain)
ALA —
_414
Dimensions: A)�4
Capacity: gallons
Design flow: VA gallons/day
Alarm level: V4 Alarm in working order Yes;a¢ No
Date of previous pumping: V.4- _
Comments:
(condition of inlet tee, condition of alarm and float switches, etc.)
DISTRIBUTION BOX:
(locate on site plan)
Depth of liquid level above outlet inven: )
Comments:
(note if level and distribution is equal, evidence of solids carryover, evidence of leakage into or out of box, etc.)
Distribution box has one lateral;No evidence of solids carry
over:No evidence of leakage into or out of the box
PUMP CHAMBER:-tba
(locate on site plan)
Pumps in working order: (Yes or No)
Alarms in working order (Yes or No) ho
Comments:
(note condition of pump chamber, condition of pumps and appurtenances, etc.)
D 1
(revised 04/25/97) peg• 7 of 10
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (continued)
Property Address: 905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inspection: 1 0/2 0/9 8
SOIL ABSORPTION SYSTEM (SAS):&
(locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods)
If not determined to be present, explain:
Type:
leaching I
pits, number:
leaching chambers, number:
leaching galleries, number:
leaching trenches, number,length:
leaching fields, number, dime sions:
m overflow cesspool, nuber:
Alternative system:
Name of Technology: .P,
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Loamy sand to sand & gravel No signs of Uydraulir failure or
pond i ng-A 1 1 vagataf i nn i s nnrma l
CESSPOOLS:
(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 (cesspool must be pumped as part of inspection)
Cesspools are not present
Comments:
(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.)
Cesspools are not present.
PRIVY: (fQ
(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.)
Privy is not present.
(revised 04/25/97) Page 8 of 10
SUBSURFACE SENYAGE,OISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION (coniinvcd)
Plopcnr Addled: 905 West Main Street Hyannis,Mass.
O.:nelt Rosalie Melody
o,ie or inrpcction, 1 0/20/98
SKETCH Of SEWAGE DISPOSAL SYSTEM:
inclvdc ties to at least two permanent references landmarks or benchmarks
locale all well) within too (locate where pvblic water svpplY tomes into hovst)
I
q05 w (YLAi,/i1 CRxL�ex�va
v
SUBSURFACE SEWAGE DISP(: L SYSTEM INSPECTION FORM
..: : C
SYSTEM INFOP'.. .!ION (continued)
Property Address:.905 West Main Street Centerville,Mass.
Owner: Rosalie Melody
Date of Inspection: 1 0/2 0/9 8
Depth to Groundwater J6- Feet
Please indicate all the methods used to determine High Groundwater EIE!Vation:
Obtained from Design Plans on record
Observation of Site (Abutting property, bservation hole, basement-sump etc.)
Determine it from local conditions
Check with local Board of health
Check FEMA Maps
!/f heck pumping records
Check local excavators, installers
Use USGS Data
Describe in your own words how you established the High Groundwxer Elevation. Must be completed)
Water Contours Map
Gahrety & Miller Model
12/16/94
(revisal 04/25/97) Pas. 1.bof 10
[�_
pR/1Tn.IlT...'w1./R1..1w•► 1.nRwn./nrrA TOWN OF Barnstable BOARD OF HEALTH
SUDSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM - PART D •- CERTIFICATION
� 1^•rn-T•••::.—�..��.rr��nw+u+.nr..rrsrsRwmzr--a�.nv'wn�w�—'�wrwwv.�+ww.�n�� wnn v�v-rr•r+^..—.
.-TYPE OR PAINT CLEARLY-
PROPERTY INSPECTED
STREET ADDRESS 905 West Main Street Centerville,Mass . '
ASSESSORS MAP, BLOCK AND PARCEL
OWNER' s NAME Rosalie Meiody
v�
PART D - CERTIFICATION
NAME OF INSPECTOR Joseph P.Macomber Jr.
COMPANY NAME J.P.Macomber & 9r1n' Inc.
COMPANY ADDRESS Box 66 Centerville,Mass. 02632
Strevt Town or City State LIP
COMPANY TELEPHONE ( 508 1 775 - 3338 FAX ( 508 ) 790 - 1578
CERTIFICATION STATEMENT
I certify that I have personally inspected the sewage disposa'1 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 ne :
System PASSED ,
The inspection which I have conducted has not found any information
which indicates that the system fails to adequately protect public
health or the environment as defined in 310 CMR 16 . 303 . Any failure
criteria not evaluated are as stated in the FAILURE CRITERIA section of
this form.
System FAILED*
The inspection which I have con cted has found that the system fails to
protect the public health and the environment in accordance with Title
6 , 310 CMR 15 . 303 , and as specifically noted on PART C - FAILURE
CRITERIA of this Inspection form .
Inspector Signature Date
One copy of this certification must be provided to the OWNER, the BUYER
( where applicable ) and the BOARD OF HEAL'1'II.
* If the inspection FAILED, .the owner or'" perator shall u d
within o'ne year of the date of the inspection, unless allowed ortrequiredm
otherwise as provided in 3.10 CMR 16 . 306 ,
partd .doc
y t
( .s 6 t q cr
No...��1 r-• -�-- Fss.....�2..0....
THE COMMONWEALTH OF MASSACHUSETTS
BOAR® OF HEALTH Qw�
TOWN OF BARNSTABLE j
App iration for Digpniai lvorkg Cnoniitrurti • rrrm
Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal
System at:
r
............... ...�....'. 1 .................--------- ..................._
Aeof
T�apation-Addres or Lot No.
5.............. .....•............ ....................- ............•.. •....................
OAdd' .......................... . . - 0_�.� ..-----....
Installer Address
Tuilding Size Lot............................Sq. feet
Dwelling—No. of Bedrooms....._,�--_--.-.--•...................Expansion Attic ( ) Garbage Grinder ( )
P4 Other—T e of Building No. of persons............................ Showers
Pa.� —Type g ---------------------------- P ( )--- Cafeteria ( )
Other fixtures ------------------------
W Design Flow............................................gallons per person per day. Total daily flow----------------------------------------.....gallons.
WSeptic Tank—Liquid capacity............gallons Length................ Width................ Diameter.---.----.-.---- Depth................
x Disposal Trench—No. .................... Width...-................ Total Length.................... Total leaching area....................sq. ft.
Seepage Pit No..................... Diameter....----.--......... Depth below inlet.................... Total leaching area..................sq. ft.
Z Other Distribution box ( ) Dosing tank ( )
aPercolation Test Results Performed by.......................................................................... Date.......•................................
Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................
fro Test Pit No. 2................minutes per inch Depth of.Test Pit.................... Depth to ground water..--................---.
P4 ----------------------------- ......................................-.............•...............................................•..........................
0 Description of Soil............................................................................------------- .
V ................•------.....---...------••••--------.......------------------•-----•----------•---------••-----------•-.. ........
--- . ... -------------------•-••---------••--.......
W
x ----------------------------------------------------------------------------------------------------------------- -- ------�----- - ----- ------
U Nature of Repairs or Alterations—Answer when applicable.------- _- --- %`
loon-. ram .---- -------•-•------•--•-•••........
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance been issue th oard of health.
Signed ......... ----- . . ---.......------------------------ -R---------- ...........................
Date
.------------
p�
Application Approved By .............. ,t;�. --a ----------------------------------------------------------------------- ------- "r
Dare �I
Application Disapproved for the follow; g reasons:
--------------------------------.................................-- -- - ----------------------------- ----------------------- ---------------I...............................--.........---- --- ........................................
Dare
Permit No. .. --"-----.-.&-`c-.-_-------------_---- Issued ................... -------------------
Dare
�4
n
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE 47,C
Appliration for Disposal Works Tonsh i,an" ami#
Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal
System at:
r
--- ��- - ----------------------------___ -------------------------
tion-Addres or Lot No.
w ner
_� ------_-----------.__
---------------- --------
Installer
Address
d T of Building Size Lot---------------------------Sq. feet
U Dwell No. of Bedrooms_______��_________________________________Ex nsion Attic
� Dwelling— pa ( ) Garbage Grinder ( )
a Other—Type of Building ____________________________ No. of persons---------------------------- Showers Cafeteria
( )
d Other fixtures - - - ----- -
W Design Flow--------------------------------------------gallons per person per day. Total daily flow------------------------------------------_gallons.
WSeptic Tank—Liquid"capacity______------gallons Length---------------- Width---------------- Diameter----------------Depth__________------
x Disposal Trench—No--------------------- Width-------------------- Total Length--------------------Total leaching area-----------------sq. ft.
Seepage Pit No--------------------- Diameter_---_------------- Depth below inlet----.________------- Total leaching area----------------sq. ft.
z Other Distribution box ( ) Dosing tank ( ) I ' 1
1.4 Percolation Test Results Performed by------------------------------------------------------------------------- -
M Test Pit No. 1________________minutes per inch Depth of Test Pit-------------------- Depth to ground water________________________
Gs. Test Pit No. 2----------------minutes per inch Depth of Test Pit____________________ Depth to ground water________________________
x - -------------------------------------------------------------------------------------- -- -- ----------------------- ---
O Description of Soil--------------------------------------------------------------------
----------------------- ---- -- --- - -
%
________------—_»_»»___._»»»»__
_________________________________________________________________________________________________________________ ______ ___ ---—----_ ____ ______1__________�___._»____
U Nature of Repairs or Alterations—Answer when applicable.- r 9 ------eD®� - -
-----------------------------------------------------------------------------------------------------------------
-----------
Agreement:
The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with
the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the
system in operation until a Certificate of Compliance h, been issued byAthnbDoarda of health.
Signed --------- ----- - ---- -------------�----------- --- ------ ---------------------------------------
`'' ' law
Application Approved By ---------- CJ V �
Application Disapproved for the following rearons- --------- ----------------------------------------
Date
PermitNo. -' ----------------------- Issued ------------------------ ---------------------------------------
na� -
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF HEALTH
TOWN OF BARNSTABLE
(9er#tf rate of (lomplinure
THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( 'S,.)
by -- .»� <-, - ------------------------- ----- 3 ----------------------------------------------------------------
�, � � Insrelller
at ----------------? Q-----� ----------W - --------15-T -------------------------------------------------------------------------------------------------------------------
has been installed in accordance with the provisions of TITLE 5A The State Environmental Code as described in
the application for Disposal Works Construction Permit No- ------ .- `ate dated ____-___________________________________-__-_
THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE
SYSTEM WILL
*-F-�UNCTIOtN4 SATISFACTORY.
DATE r '" - v C - Inspector -------
THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF—HEALTH
TOWN OF BARNSTABLE
No.__!.ate___=---�l0°� Fes.��
Disposal arks Tontrudion f ermit
Permission is hereby granted °=_c,u _ ._.s ----------------
----------------------------------------------------
-------
to Construct ( ) or Repair (,-) an Individual Sewage Disposa�System
at No--------� ------- ------
----------------------------------------------------------------------
mit ���
as shown on the application for Disposal Works Construction Permit No._________,e£_-- _ Dated ---------------------
---
------------------------
Is
— Board of Health
DATE-------------------------------------------------------------------------
FORM 3680E HOBBS A WARREN.INC.,PUBLISHERS
TOWN,.OF BARNSTABLE
�}qq
LOC,TIG-A C/4 � � ,; SEWAGE #
VILLAGE_'�1° ��1• - -ASS ESSOR'S. MAP & LOT
INSTALLER'S NAME & PHONE NO.
SEPTIC TANK CAPACITY
��X_,L
LEACHING FACILITY:(type) (size) LO�
NO. OF BEDROOMS"--,5 PRIVATE WELL OR UBL1C ATER
BUILDER OR OWNER
DATE PERMIT ISSUED: -- �-
DATE COMPLIANCE ISSUED` -7 a"
VARIANCE GRANTED: Yes jj, No
u. Re v
� � 3
�3`
a
uTgrw
P
3-
37Ar .:
COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE
TOP OF FOUNDATION BROUGHT TO WITHIN 6"OF FINAL GRADE Flaherty Environmental Services
EL. 60.0' EL. 58.0' (not to scale) INSP. PORT W I 3" OF GRADE
CLEAN SAND P.O. Box 331
2" of J"to I" DOUBLE WASHED PROP. EL. 58.0' Harwich, MA 02645
4" CAST IRON or EQUIVALENT PEASTONg-OR GEOTEXTILE 774.994.1166
MIN. PITCH 1/4" PER FOOT FILTER FABRIC
4" SCHEDULE 40 PVC PIPE
4"SCHEDULE 40 PVC PIPE • ' ,'
VENT IF REQUIRED
FLOW LINE •
• !/Iist2'to be level)
-�' •,' O O O O C
O O O O
;.:.'•: L.EXIST. 14" I'MINSIR
EL.EXI L.55.6' 000000°°°°°oco0°0 ' 0°011 0°0°0°e
EL.S4.83' o 000000 0 0 0 0 0 0 � o°o°o°o°cS5,0' o00000 0000 GAS BAFFLE EL.54.8' °°00oo0000°0000000°0°0000C
0°0°0°°000 0°000° , 4 0 0 0 0
0 0 0 �• a ' °o°o°o°o°
... ..
•' e"CRUSHED STONE OR D BOX) SOIL ABSORPTION SYSTEM
•S' •'' �' •' COMPACTED
1000 GALLON SEPTIC TANK MECHANICALLY (2) 500 GALLON H-20 CHAMBERS
(EXISTING) „ WITH 4'-STONE AROUND IN A 5.3'
(DATUM: ASSUMED) _ to 1i" DOUBLE WASHED STONE 12.83'X 25'X 2' CONFIGURATION
BOTTOM OF TEST HOLE EL. 47.5' EL. 47.5'
USGS ADJUSTMENT: N/A LOCATIONMAP
GROUNDWATER ELEV: N/A
/ N TH
�� � �yZy� K'estyja7n,�
�P0 r
LOCUS
PAVED \ EXISTING
l DRIVEWAY 3 DR
DVELLI c
LOT 7 60
/ / \ EXIST. S.T. 23,100 SFf NTS a
\ o MAP 249 LOT 19 OF
GARAGE DECK
[EL'ENCHMARK. BARN DAVI'
OP OF FNDN O '1.. 1).
�1o1.47• 60.0, FLA!a
"' o pR
KENN-S c - N 8TE�
AWgVENUE l l ^� MITAM�►�
., 7 eo
• 1o.a ea / / CLIP
S8 _ DRIVEWAY
DATE.511912019 R E .
-- _/ /
( � c 60 SITE AND SEWAGE PLAN FOR
h, B &-8 EXCAVATION, INC./
MELTSSA RUSSELL
905 WEST MAIN STREET
.- - (CENTERMLE) BARNSTABLE, MA
SCALE : 1" = 40'
REF.'PB 151 PG 73 PAGE 1 OF2
4
.................................................................-..................................................................................................................................................................................................... .................................................................................................................................. ......................................................................................................................................................................................................................................................................................................................................................................
GENERAL NOTES DESIGN CAL CULA TIONS S YS TEM DETAIL Flaherty Environmental Services
P. 0. Box 331
1. ALL PRECAST COMPONENTS TO BE H-1 0 Harwich, MA 02645
RATED UNLESS OTHERWISE SPECIFIED.
NUMBER OFACTUAL BEDROOMS 3 774.994. 1166
DISTRIBUTION BOX(ES)AND ANY
COMPONENTS WITH ANY ANTICIPATED GARBAGE DISPOSAL UNIT NO
VEHICULAR TRAFFIC TO BE H-20 RATED.
2. THE DESIGN OF THIS SYSTEM DOES NOT TOTAL ESTIMATED FLOW
(110 GAUBRIDA YX 3 BR) 330 GAL./DAYALLOW FOR THE USE OFA GARBAGE
GRINDER.
REQUIRED SEPTIC TANK CAPACITY 660 GAL.
3. MUNICIPAL WATER IS AVAILABLE. -
25'
4. ALL CONSTRUCTION TO CONFORM WITH
SIZE OF SEPTIC TANK 1000 GAL. (EXISTING)
310 CMR 15.000 AND ALL OTHER
APPLICABLE LOCAL, STATE AND FEDERAL SOIL CLASSIFICATION
CODES AND REGULATIONS.
DESIGN PERCOLA TION RATE <2 MIN./INCH5. INSTALLERICONTRACTOR TO REVIEW&
VERIFY ALL ELEVATIONS AND DETAILS
AND REPORT ANY DISCREPANCIES TO EFFLUENT LOADING RATE 0.74 GAL./DAY/FT'
DESIGNER PRIOR TO CONSTRUCTION OR 12,83'
LEACHING AREA
ASSUME ALL RESPONSIBILITY.
(2)x(25.0'+ 12.83)(2) = 151SF
6. INSTALLER/CONTRACTOR IS 25.O'x 12.83' =320 SF
RESPONSIBLE FOR MAINTAINING SAFE 471 SF x 0.74 =348 GPD
WORK AREA, VERIFYING ALL UTILITIES
AND NOTIFYING "DIG SAFE" USE(2)500 GALLON H-20 CHAMBERS WITH 4,STONE
(1-888-344-7233) 72 HOURS PRIOR TO INA 12.83'X25'CONFIGURATION ASDIAGRAMMED
CONSTRUCTION.
Z ANY CHANGES TO OR DEVIATIONS FROM
RESERVE LEACHING CAPACITY NIA GPD
THIS PLAN MUST BE APPROVED IN
WRITING BY FLAHERTY ENVIRONMENTAL
SERVICES AND LOCAL BOARD OF
HEALTH.
8. FINISH COVER OVER COMPONENTS IS
NOT TO EXCEED 3'PER 310 CMR 15.000 (NTS)
UNLESS SHOWN PER PLAN
9. ALL ABANDONED SEPTIC SYSTEM
COMPONENTS TO BE PUMPED DRY AND SOIL EVAL UA TION
FILLED WITH CLEAN SAND OR REMOVED
TESTHOLE#1 P#I"f TESTHOLEW P#f"I
AND REPLACED WITH CLEAN SAND. Evaluator. David D.Flaherty Jr.,RS,REHS Evaluator David D.Flaherty Jr.,RS,REHS
OF Alq
10.ALL COMPONENTS TO BE PROVIDED SE#2755 SE#2755
BOH WID7888. David Stanton,RS BOHMness. David Stanton,RS D
WITH WA TER TIGHT ACCESS PORTS Date.- May 16,2019 Date., May 16,2019
WITHIN 6"OF FINISH GRADE,
11,ALL SEPTIC TANKS, DISTRIBUTION F
TH-I ELEV 58.0' TH-2 ELEV.58.0' 0.
BOXES AND PIPING TO BE INSTALLED
0'-8- A LS IOYR312 0.-8.
WATERTIGHT A LS 10YR 312 1 TIE
12.NO KNOWN WETLANDS OR WELLS
All AM
WITHIN 100 FEET OF PROPOSED 8'-33- B LS 10YRM -33.
8 LS I0YR516
LEACHING.
13,THIS IS NOT A CERTIFIED PLOT PLAN
AND UNDER NO CIRCUMSTANCES IS THIS
7 car*that on November 12,2002,/have passed
F/(51 Pero AND SEWAGE PLAN
PLAN TO BE USED FOR ZONING OR
the exam/nation approved by the Department of
BUILDING PURPOSES. Environmental Protection and that the above analysis FOR
has been performed by me consistent mdffi the
14.LOT IS SHOWN AS ASSESSOR'S MAP 2 8 & B EXCAVATION, INC"/
required VaInIng expertise and experience d-cribed
LOT, I
33'-126' C2 MS 2.5Y614 33'-120' C2 US 2.5Y614 In 3 10 CMR 15.018(2). MELISSA RUSSELL
15.LOCVS PRO�EOTY IS LOCATED WIT, IN
AN AQUIFER PROTECTION DISTRICT 905 WEST MAIN STREET
(CENTERMLE)
G.W ELEV.WA G.W ELEV.NIA
(ZONE 11).
BOTTOM TH-1 ELEV. 47.5'. BOTTOM TH-2 ELELEV. BARNSTABLE, MA 48.0'.
PAGE20F2
..................... ............................................................... ............................................ ................ ..................................... ................................................... .. .. ........................ .....................................................................
................. .................................................................................................................................................................................................................................................................. ...................................................................
.......................
COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services
TOP OF FOUNDATION BROUGHT TO WITHIN 6" OF FINAL GRADE
EL. 60.0' EL. 58.0' (not to scale) INSP. PORT W I 3" OF GRADE
CLEAN SAND P.O. Box 331
2" of e" to Z" DOUBLE WASHED PROP. EL. 58.0' Harwich, MA 02645
4"CAST IRON or EQUIVALENT PEASTON15-011 GEOTEXTILE774.994. 166
FILTER FABRIC
MIN. PITCH 1/4" PER FOOT
4"SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE
N '.. VENT IF REQUIRED
FLOW LINE ffiist2'tobelevel)
30' 2% 5 (l%) 55
'r ••:•. ••„ .••. . •.
-- ' '• •) 00000000C
En
L.EXIST. 14 0 0 0 0 0 0 E 0 0 0 o e
EL.EXI _i —� o°o°o°o°o° 0 0 .'®� R gyp} 0°o°O°o°c
EL.55.6' o 0 0 0 0 0 � � r`�t o 0 0 0
000 000o C� L`_J 0000c
' EL.54.83' o° 0°000000000 0°0°o°o°e 2.0'
EL.55.0' 0 0000000°00000 p o°0°o°o°c—
GAS BAFFLE EL.54.8' 0°0°0°0°0° 00000E 0���.. ® 1000 0 0 0
•.;..• 000000000E 0000E •O' w 000000c
0 000
0 E .2 0 0 •• 4 °°°°°°°O° EL.52.8'
(H 20 aeox) SOIL ABSORPTION SYSTEM
• ° •, • •• 6"CRUSHED STONE OR
•1' •' •• MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS
' 1000 GALLON SEPTIC TANK 5_3'
(DATUM: ASSUMED) (EXISTING) 3i to 11" DOUBLE WASHED STONE WITH 4'STONE AROUND IN A
7� 12.83'X 25'X 2' CONFIGURATION
BOTTOM OF TEST HOLE EL. 47.5' EL. 47.5'
USGS ADJUSTMENT: N/A LOCATIONMAP
GROUNDWATER ELEV: N/A
�.( N TN
` CO EXISTING B w��Ma�ns r
` 3 BR
V�
�J DWELLING LOCUS�
3
1 NTS
n
A .ems"�As Built
GARAGE DAVID
DECK
FLA E R.
3 905 West Main Street i
' ® GISTER
Centerville, MA sgNITARIP
TO :
DATE.TO -5 REVISED:
1 2 3 4
A 26' 25' 23 27' AS BUZLT KEn/NESgwAV � B� e Excava rro F rnrc./
B 26'5u 32' 39'7° 42'5" EN(JE MELZSSA RUSSELL
905 WEST MAIN STREET
NOT TO SCALE (CENTERVZLLE) BARNSTABLE, MA
REF.PB 151 PG 73 PAGE 1 OF 1
f
TOP OF FOUNDATION COVERS TO BE WATERTIGHT AND SEPTIC SYSTEM PROFILE Flaherty Environmental Services
BROUGHT TO WITHIN 6"OF FINAL GRADE
EL. 60.0' EL. 58.0' (not to scale) INSP. PORT W I 3" OF GRADE
CLEAN SAND P.O. Box 331 ,
2" of e" to k DOUBLE WASHED PROP. EL. 58.0' Ha/Wich, MA 02645
PEASTON5-OR GEOTEXTILE
4"CAST IRON or EQUIVALENT FILTER FABRIC 774.994.1166
MIN. PITCH 1/4" PER FOOT
a^SCHEDULE 40 PVC PIPE 4" SCHEDULE 40 PVC PIPE '
`-
VENT IF REQUIRED
FLOW LINE (firsr2'rotrerever)
30' 2% "�
-_ s o 1 I f ' •• o
L.EXIST. o 0 0 0
�jp o 0 0 o c
EL.EXI �EL5S.61 0000000 00 o o°o° ®� u L—' 0gogogooc
EL.54.83' 000 0 0 0°0°0°0° ��p ®� ® 00°0°0°0° '
EL.55.0' 0 0 o°o°o°o°o°o°o o°o°o°o°e 2—D
EL.54.8' 000°000000 000000 �® ®��� ® 000o0o0oc
" GAS BAFFLE o0000000 •a• . o000
• .� °o°o°o°o° o°o°o° •. a °o°o°o°o° EL.52.8'
(If20 aeoxq SOIL ABSORPTION SYSTEM
• '• •, • •• 6"CRUSHED STONE OR
I. •S' 1''� MECHANICALLY COMPACTED (2) 500 GALLON H-20 CHAMBERS T_
1000 GALLON SEPTIC TANK 5.3'
(DATUM: ASSUMED) (EXISTING) „ � WITH 4' STONE AROUND IN A
to 1�„ DOUBLE WASHED STONE 12.83'X 25'X 2' CONFIGURATION
BOTTOM OF TEST HOLE EL. 47.5' EL. 47.5'
USGS ADJUSTMENT: N/A LOCATIONMAP
GROUNDWATER ELEV: N/A
N TH
`�5 EXISTING B
•(�P 3 BR
DWELLING � LOCUS
3
1 NTS
As Built A �HOF
GARAGE DECK � DAV
905 West Main Street 3 F E R.
•
�.• ® �¢ISTE�
Cen terville, MA ; ' 8gN17AR�P�
_ (�
T❑ DATE.•5/29/2019 REVI ED.
1 2 3 4
A 2 6' 2 5' 23 2 7' KENNES, AS BUILT PLAN FOR
q W,q�E ; � B& B EXCAVATION, sn►c./
B 26'5N 32' 39'7# 42'S" N�/E
MELISSA RUSSELL
905 WEST MAIN STREET
NOT TO SCALE (CENTERVILLE) BARNSTABLE, MA
REF:PS 151 PG 73 PAGE 1 OF 1