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HomeMy WebLinkAbout0015 WASHINGTON BURSLEY WAY - Health 15 Washingon Bursley Way Centerville P A = 172 186 TOWN OF BARNSTABLE L!6CA"110N l5 SEWAGE # *11 LAGE Cr d��f/d L Lt ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. 9 SEPTIC TANK CAPACITY �Od LEACHING FACILITY: (type) (size) NO. OF BEDROOMS BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the:. Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and.Leaching Facility (If any wetlands exist within 300 feet of leaching facility) Feet Furnished by D IQQi 495 AcU PAa` 86 a5 �c� Commonwealth of Massachusetts �(/7� 1�" Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out A. General Information forms on the computer,use 1. Inspector. only the tab key to move your Matthew F. Gilfoy cursor-do not Name of Inspector use the return key. B&B Excavation Company Name � 14 Teaberry Lane Company Address Sandwich Ma. 02644 �d11' City/Town State Zip Code (508)477-0653 S113640 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority 3-27-15 Inspector's Sig ature f Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system ill perform in the future under the same or different conditions of use. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M yY 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is Centerville Ma. 02632 3-27-15 required for every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ® I have not found any information which indicates that any of the failure.criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments J 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other. D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve& Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. Cityfrown State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. Cityfrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? M ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS located on site? Y P 9 , ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 336 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection D. System. Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d see below 9 ( Y 9 (gP ))� Detail 2013-76,000 2014-79,000 Sump pump? ❑ Yes ® No Last date of occupancy: current Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste.holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 N Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: pumper driver Was system pumped as part of the inspection? ® Yes ❑ No If yes, volume pumped: 1000 gallons How was quantity pumped determined? tank size Reason for pumping: maintenance Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the.DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 2010 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): At time of inspection building sewer appeared to be in good working order no sign of leakage. Septic Tank(locate on site plan): 1' 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 Dimensions: 1000 gal. Sludge depth: 6" l5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Washington Bursley Way Property Address Steve& Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 5" Distance from top of scum to top of outlet tee or baffle 6 Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? measured Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): At time of inspection septic tank appeared to be in working order,Tees present no sign of back- up.Liquid level equal with outlet invert. Tank was pumped after inspection for maintenance. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts _ - Title 5 Official Inspection Form wow Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM , 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): At time of inspection d-box appears to in working order no sign of carryover. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments wM 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 24 infiltrators(quick 4's) ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): At time of inspection leaching appears to be in working order with no sign of hydraulic failure. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Tit e 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments '~0 15 Washington gton Bursle.Y Way Property Address Steve&.Marsha Mele Owner Owner's Name, information is Centerville Ma. 02632 3-27-15 required for . — every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch:Of Sewage Disposal System: Provide 9-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 /per BACV� of HDnE a Ai — (o�� A3 "11' 3 5' fJ� _ V2o 3t t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar ® Shallow wells Estimated depth to high ground water: No Gw 144" 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: Dec-6-2010 Date ❑ Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Plan on file Before filing this Inspection Report, please see Report Completeness Checklist on next page. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 15 Washington Bursley Way Property Address Steve & Marsha Mele Owner Owner's Name information is required for Centerville Ma. 02632 3-27-15 every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 T� Office: 508-862-4644 FAKE� Town of Barnstable V Fax: 508-790-6304 Regulatory Services Department BARNFrABLE. ` Public Health Division v MASS. � Thomas A.McKean,CHO 4T t639� `� 200 Main Street,Hyannis, MA 02601 fD MP a Payment Receipt Septic Inspection Payment received: $25.00 (Check) on 4/9/2015 Permit number: 10748 Check number: 1866 Check amount: $25.00 Name on check: B &B Excavation Owner: MARSHA&STEVEN A MELE Address: 15 WASHINGTON BURSLEY WAY,Centerville Town of Barnstable Department of Regulatory Services .UMST„11M a Public Health Division Date h'16 9. 200 Main Street,Hyannis MA 02601 Date Scheduled J Time Fee Pd. /vU Foil Suitability Assessment fore ,� e Ibis Performed By:_ y �p S d- Disposal Witnessed By:_ D 4 V i � S ";;"r 4, /(�f Location Address LOCATION& GENERAL INFORMATION Owner's Name ► at'Lg(-f A `^ '�/�-e✓t/� �� e / Address y Assessors Map/Parcel: /'�oja l 72_ /0�(86 �- (a. -ffS�n�Y 1 SuQ� (rrff �� Engineer's Name �-G °�/(� NEW CONSTRUCTION 3 -574A �lh/IC14; � ? /REPAIR ""�w� Telephone# jZ —3 Land Use aX Slopes(%) Surface Stones Distances from: Open Water Body N ft possible Wet Area v ft ft Drinking Water w,:i1 Drainage Way N�/E ft Property Line -- _ft Other TZ;Ls I'te I,/ l ' SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) �5 G-A-zVj Ak a �� - -36a rn Ix It,, 01 4 99 9 � tr 2.�eej�r,�ac Parent material(geologic) �' cJ Depth to Bedrock_- ^�/A Depth to Groundwater. Standing Water in Hole: �//i�- Weeping from Pit Face Estimated Seasonal High Groundwater I Z _ DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: J/Ar Depth Observed standing in s- 6-Te 1 I th to soil mottles: (n, Depth to weepingftDmlile of obs.hole: _ in. Groundwater AdJumtme ft. Index Well# ading Date: IndexWel - Adj.&ctor Adj Oroundwater level, Observation PERCOLATION TEST Dgte t?--3-te ate tta� Hole# /A X(5B a) Time at 4" Depth of Pere //; 9 tJ Time at 6" Start Pre-soak Time @ ' 17 Time(9 End Pre-soak Rate Min./Inch Z Jv{ e Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Al o Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100',of wetland,you must first notify the, Barnstable Conservation Division at least one(1) week prior to beginning. Q:ISEPTICIPERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture .Sdil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. lY Q n i tenry.%Graven ZZ � ZZ c�Y s2 Z S DEEP OBSERVATION HOLE LOG Hole# x(sy.1) Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsi ency,% rave yg/^_mow•,'�/, �� Z.Sy714 s ydVe DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. ConsistencL%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones',Boulders. Consistency.%GraXtI Flood Insurance Rate May: / Above 500 year flood boundary No— Yes ✓__/ Within 500 year boundary No= Yes Within 100 year flood boundary No. Yes .. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? ` tS If not,what is the depth of naturally occurring pervious material?„ Certification I certify that on -4, (date)I have passed the soil evaluator examination approved by the Department of En ironmental Protection and that the above analysis was performed by me consistent with . the required trainin exp rtise and experien described in 310 CMR 15.017. Signature //. 0-z, Date 1Z" 3">o Q:\SEPTICIPERCFORM.DOC No. I !�.� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:�1 PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpfication for Misposar *pstrm Construction 3permit Application for a Permit to Construct( ) Repair(�ade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. 15 �cc% vner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,apt 1.No. Designer's Name,Address,and Tel.No. 00( (!& - ADS Type of B ilding: 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) lj gpd Design flow provided 2� gpd Plan Date Number of sheets Revision Date Title Size of Septic Tank ���1�_ �G. Type of S.A.S. /D/,,7/-- � Description of Soil -T Nature of Repairs or Alterations(Answer when applicable) 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 6 place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Date Application Approved by G Date ppApplication Disapproved by Date for the following reasons Permit No. Date Issued_� �� —I f_ - - - - - ---------------------------------- -a _- No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION -' TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for Disposal 6pstem,Construrtion permit Application for a Permit to Construct( ) Repair( Upgrade( ) Abandon( ) ❑Complete'System ❑Individual Components Location Address or Lot No. /�5 �z7Sh/'�� ',7 /Yner's Name,Address,and Tel.No. ' Assessor's Map/Parcel �'� — �Q� �r l,� S`i� 11�'` 1,,I, Installer's Name,Address,and Tel No. Designer's Name,Address,and Tel.No. (4vr AlOftl �(-fhm '%--noo FKr--:F617 Type of Building: t Dwelling No.of Bedrooms Lot Size � sq.ft. Garbage Grinder( ) Other Type of Building ©o-lf No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /y gpd Design flow provided 3 gpd Plan Date Number of sheets Revision Date Title 'Size of Septic Tank 106)a e,,9W G Type of S.A.S. Description of Soil i 4 Nature of Repairs or Alterations(Answer when applicable) OX Date last inspected: fin. 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 no;o place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Signed Datekzol4i� Application Approved by Date ? f� Application Disapproved by Date for the following reasons Permit No. 0 �/ i L Date Issued �- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance � THIS IS TO CERTIFY that,the On-site Sewage Disposal system Constructed( ) Repaired(Upgraded( ) Abandoned( )b at /� iJ/fjf�//r� /1 ��� �Y has been constructed in accordance with the provisio s of Title 5 d the for Disposal System Construction Permit No. dated Installer C �.�/� Designer— s #bedrooms Approved design flow gpd The issuance of this pe 't shall not be construed as a guarantee that the system wil ncttiol as design�d. n Date ( } �170 Inspector T / 6.N 2)__� -------------------------------�(---- -------- - _ ---=-- _--- ------- ------=-------- No. V V ! Fee 6P i THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE, MASSACHUSETTS Disposal *pstrm Construction Vertnit Permission is hereby granted to Construct( ) / Repair Upgrade( ) Abandon( ) 3 System located at �� 19 fyZ?i' ,�/S 'l G✓� 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:!�tructi -i-mustbempleted within three years of the date of this permit. Date t // '�I Approved by Town} of Barnstable w DFIKE 1 -o Regulatory. Services Thomas F::Geiler,Director . . . .&ALR,c,9rA8M - M^SS- Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Desi ner Certification Form Date: k 4- Designer: Installer: V"o�"�- Address: � � `1Z`j Address: On oZPO'';`�, �—t.sO-SIL was issued a permit to install a (date) ,r (mst`al(lerr)),f / septic system at �cJ w �� �I" ��/ `t ��Y based on a design drawn by (address) LQ ,'wk\t�°�"/ 1�= _ dated (designer) - I certify that the septic system referenced above was installed substantgn ially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral 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 designer to follow. N OF MAS Sq DAVI D cyGN 1'(El staller Signature) D. FLAHEF2TY JR. No. 1211 J\ SgN17AR\P' (Designer's Signature) (Affix Designers tamp ere 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:Health/septic/De,iper Certification Form 9 COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete*ems 1,2,and 3.Also comoito 3 y ture item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that We can return the card to you. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. fA't1?' 1. Article Addressed to: D. Is delivery a , from item 1? El Yes If YES, tVelivery a 1-3 No Gym s jbelow: , w 3. Servic BODertified Mail ❑Express Mail 6�� Z ❑Registered _ ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7007 3020 0001LL 3429 8219 (Transfer from sevice label) ` P$Form 3811,February_2004 Domestic Return Receipt 102595-02-M-1540 Y UNITED STATES POSTAL SERVICE `" �<•�-E;;,: '�t�r MA.;�Q- es Paid • Sender: Please print your name, address and.Zt * ifi" its box M Town of Barnstable 4 Health Division 200 Main Street Hyannis,MA 02601 c, lillAiliii1llllii1i till if1111tiliiil Of SF4E T°� Town of Barnstable lh-Barnstable Regulatory Services Department ;edcaM " RARNS-TABLE. 1639.�. Public Health Division Alf µAs A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 FAX: 508-790-6304 Thomas F.Geiler,Director Thomas A.McKean,CHO Marsha Mele 15 Washington Bursley Rd. . Centerville, MA 02632 CERTTIFIED MAIL 7007 3020 0001 3429 8219 June 17, 2009 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000 STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION AND THE TOWN OF BARNSTABLE CODE CHAPTER 170. The property owned by you located at15 Washington Bursley Rd., Centerville, was inspected On June 12, 2009 by Jaime Cabot, R.S. Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.300 & 310 CMR 15.00—Title V. Septic system (permit# 77-343) capacity is only for 3 bedrooms; 4 bedrooms observed. 105 CMR 410.450-Means of Egress: No second emergency egress is provided from bedroom in basement. 105 CMR 410.482- Smoke Detectors: No Carbon Monoxide Detector provided for habitable space in basement( finished room). The following violations of the Town of Barnstable Code were observed: 170-4— Certificate of Registration. Rental property is not registered with Town of Barnstable Health Department. You are directed to correct the violations listed above within twenty four (24) hours of your receipt of this notice by removing all beds from the basement bedrooms and ceasing and desisting from using the basement bedroom lacking proper egress as sleeping quarters. You are ordered to install basement smoke detectors in accordance with Mass. Fire Codes you are ordered to install a Mass. State Building Code approved egress window prior to resuming use of the basement bedroom for sleeping purposes. You are ordered to correct the violations listed above within sixty (60) days of your receipt of this notice by pulling any required building permits to restore the property to a three bedroom home. You are ordered to remove a bedroom by removing entrance doors and by opening an entrance to a bedroom to a minimum of five foot wide opening. This will bring the total bedroom count down from four (4) to the appropriate three (3) as designated by your septic permit. You are ordered to register the rental property with the Health Department within thirty days of your receipt of this notice. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of$100.00 per-violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division an k to speak.with the inspector who performed the inspection. (=., BOARD OF HEALTH CHO Director of Public Health Town of Barnstable • FORM30 C_IW HOBBS&WARREN TM THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN a DEPARTMENT ADDRESS C 06F� �Caeizl TELEPHONE Address I�1Lc Tyt.1 -� Occupant_ Li SA. C, Gaya Floor 1 6ASEZrrient No. Flo. of upants 2 - No.of Habitable Rooms No.Sleeping Rooms_, No. dwelling or rooming units No.Stories: Name and address of owner S r SAS."I*J Q &..,PSL" v, I%-L-C Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish Containers: Drainage Infestation Rats or other: STRUCTURE EXT. Steps,Stairs, Porches: Dual Egress: and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof Gutters, Drains: Walls.- Foundation: Chimney: BASEMENT Gen.Sanitation: -S.vi,- o (j Dampness: n ® VC. CS9_ A io G("V Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: rjo -( Z ox, 4-5-2- Hall, Floor,Wall,Ceiling: u ¢NA 6-IJT Hall Lighting: Hall Windows: GOE61LFZVPO HEATING Chimneys: Lv I ceG riv . / v ` Central ❑ Y ❑ N Equip. Repair AA TYPE: Stacks, Flues,Vents: k i-C, SC-1 7!t PLUMBING: Supply Line: A►c,.j'e Qlj ❑ MS ❑ ST ❑ P Waste Line: O 0� H.W.Tanks Safety and Vent s ELECTRICAL Panels, Meters,Cir.: 11110 ❑ 220 Fusing,Grnd.: AMP: Gen.Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen Bathroom Pantry Den —Living Room Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: General Building Posted /Va f,4 SIX42-C-0 15 01 1770 Locks on Doors: ONE OR MORE OF THE VIOLATIONS CHECKED ABOVE IS A CONDITION WHICH MAY MATERIALLY IMPAIR THE HEALTH OR SAFETY AND WELL-BEING OF THE OCCUPANT AS DETERMINED BY 105CMR 410.750 OF THE CODE OR THE AUTHORIZED INSPECTOR.(See Over) "THIS INSPECTION RF5PORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES F PER -n INSPECTOR '1 'S TITLE ��S ���U.� DATE C, ` 2I a — TIME P.M. ►* A.M. THE NEXT SCHEDULED REINSPECTION 1 P.M. 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shall be deemed conditions which may endanger or impair the health, or safety and well-being of a person or persons occupying the premises. This listing is composed of those items which are deemed to always have the potential to endanger or materially impair the health or safety, and well-being of the occupants or the public. Because Chapter 11, 105 CMR 410.100 through 410.620 state minimum requirements of fitness for human habitation, any other violation has the potential to fall within this category in any given specific situation but may not do so in every case and therefore is not included in this listing. Failure to include shall in no way be construed as a determination that other violations or conditions may not be found to fall within this category. Nor shall failure to include affect the duty of the local health official to order repair or correction of such violation(s) pursuant to 105 CMR 410.830 through 410.833 nor shall failure to include affect the legal obligation of the person to whom the order is issued to comply with such order. (A) Failure to provide a supply of water sufficient in quantity, pressure and temperature, both hot and cold, to meet the ordinary needs of the occupant in accordance with 105 CMR 410.180 and 410.190 for a period of 24 hours or longer. (B) Failure to provide heat as required by 105 CMR 410.201 or improper venting or use of a space heater or water heater as prohibited by 105 CMR 410.200(B)and 410.202. (C) Shutoff and/or failure to restore electricity or gas. (D) Failure to provide the electrical facilities required by 105 CMR 410.250(B), 410.251(A), 410.253 and the lighting in com- mon area required by 105 CMR 410.254. (E) Failure to provide a safe supply of water. (F) Failure to provide a toilet and maintain a sewage disposal system in operable condition as required by 105 CMR 410.150(A)(1)and 410.300. (G) Failure to provide adequate exits, or the obstruction of any exit, passageway or common area caused by any object, including garbage or trash, which prevents egress in case of an emergency 105 CMR 410.450, 410.451 and 410.452. (H) Failure to comply with the security requirements of 105 CMR 410.480(D). (1) Failure to comply with any provisions of 105 CMR 410.600, 410.601 or 410.602 which results in any accumulation of gar- bage, rubbish, filth or other causes of sickness which may provide a food source or harborage for rodents, insects or other pests or otherwise contribute to accidents or to the creation or spread of disease. (J) The presence of leadbased paint on a dwelling or dwelling unit in violation of the Massachusetts Department of Public Health Regulations for Lead Poisoning Prevention and Control, 105 CMR 460.000. (See M.G.L. c. 111 @@ 190 through 199.) (K) Roof,foundation, or other structural defects that may expose the occupant or anyone else to fire, burns, shock, accident or other dangers or impairment to health or safety. f (L) Failure to install electrical, plumbing, heating and gas-burning facilities in accordance with accepted plumbing, heating, gas-fitting and electrical wiring standards or failure to maintain such facilties as are required by 105 CMR 410.351 and 410.352, so as to expose the occupant or anyone else to fire, burns, shock, accident or other danger or impairment to health or safety. (M) Any defect in asbestos material used as insulation or covering on a pipe, boiler or furnace which may result in the release of asbestos dust or which may result in the release of powdered, crumbled or pulverized asbestos material in violation of 105 CMR 410.353. (N) Failure to provide a smoke detector required by 105 CMR 410.482. (0) Any of the following conditions which remain uncorrected for a period of five or more days following the notice to or knowledge of the owner of said condition or conditions: (1) Lack of a kitchen sink of sufficient size and capacity for washing dishes and kitchen utensils or lack of a stove and oven or any defect that renders either inoperable. (2) Failure to provide a washbasin and shower or bathtub as required in 105 CMR 410.150(A)(2)and 410.150(A)(3)or any defect which renders them inoperable. (3) Any defect in the electrical, plumbing or heating system which makes such system or any part thereof in violation of generally accepted plumbing, heating, gasfitting, or electrical wiring standards that do not create an immediate hazard. (4) Failure to maintain a safe handrail or protective railing for every stairway, porch balcony, roof or similar place as required by 105 CMR 410.503(A)and 410.503(B). (5) Failure to eliminate rodents, cockroaches, insect infestations and other pests as required by 105 CMR 410.550. (P) Any other violation of 105 CMR 410.000 not enumerated in 105 CMR 410.750(A)through (0)shall be deemed to be a con- dition which may endanger or materially impair the health or safety and well-being-of an occupant upon the failure of the owner to remedy said condition within the time so ordered by the Board of Health. COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS u W DEPARTMENT OF ENVIRONMENTAL PROTECTION A d RECEIVED OCT 2 2 2003 TOWN OF BARNSTABLE TITLE 5 HEALTH CREPT. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Iles— �%U-COI Owner's Name: DAVE MCCARTHY Owner's Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02JV Date of Inspection: 10/6/03 Name of Inspector: (please print) JOHN GRACI,INC. MAP Company Name: SEPTIC INSPECTIONS w �$ Mailing Address: P.O. BOX 2119 TEATICKET,MA. 02536 PARCEL, ; LOT 9'a Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes _ Conditionally ses _ Needs Furth aluation by the Local Approving Authority Fails Inspector's Signature: Date: 10/6/03 The system inspector shall submit copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspect' n. if the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. ****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. Titles 5 TncnP.r.tinn Fnn-n (,/1 5/?0W) Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSED TITLE V INSPECTION. RECOMMEND PUMPING NOW AND THEN EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. 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. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a 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: n/a n/a 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: n/a � I _ i r-agu-) U1 1 1 OFFICIAL INSPECTION FORM- NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance n/a **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: n/a Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped NO PUMPING INFORMATION. - X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone l of a public well. _ X Any portion of a cesspool or privy is within 50 feet of a private water supply well. X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] NO (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant, or Board of Health _ X Were any of the system components pumped out in the previous two weeks X _ Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up `? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the r p oper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no X _ Existing information.For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO 5 Water meter readings, if available(last 2 years usage(gpd)):.t Sump pump(yes or no): NO 1 � � Last date of occupancy: n/a 0LAJ COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings,-if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: NO PUMPING INFORMATION Was system pumped as part of the inspection(yes or no): YES If yes,volume pumped: 1000gallons--How was quantity pumped determined? n/a Reason for pumping: MAINTENANCE TYPE OF SYSTEM X Septic tank,distribution box, soil absorption system _Single cesspool _Overflow cesspool _Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a Approximate age of all components,date installed(if known)and source of information: 1977 PER OWNER Were sewage odors detected when arriving at the site(yes or no): NO F Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 BUILDING SEWER(locate on site plan) Depth below grade: 22" Materials of construction:_cast iron _40 PVC Xother(explain): 20 PVC Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage, etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 16" Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: L 8' 6" H 5' 7" W 4' 10"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 6" Distance from top of scum to top of outlet tee or baffle: 4" Distance from bottom of scum to bottom of outlet tee or baffle: 14" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): SEPTIC TANK AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): n/a 7 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Addres s: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil,condition of vegetation,etc.): LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. SYSTEM SHOWS NO SIGNS OF FAILURE.PIT HAD F OF LIQUID IN IT AT TIME OF INSPECTION. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation,etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a 4 Page 8 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no):NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover,any evidence of leakage into or out of box, etc.): NO D-BOX,SNAKED THROUGH. PUMP CHAMBER:_(locate on site plan) Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a R Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 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. V� A PC �n Page 11 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY WAY CENTERVILLE,MA 02632 Owner: DAVE MCCARTHY Date of Inspection: 10/6/03 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12+feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked, date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators, installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: HAND AUGER- 12+FT. 11 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS ID DEPARTMENT OF ENVIRONMENTAL PROTECTION m d t , Y' TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner's Name: C/O FRANK GRIMALDI Owner's Address: 875 MASS AV. SUITE 31 CAMBRIDGE MA.02139 Date of Inspection: 9/28/01 S Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: "'P.O.BOX 2119 TEATICKET,MA.02536 1 Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems.I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: X Passes . ' _ Conditionally Passes _ Needs Fu Evaluation by the Local Approving Authority F; Fails Inspector's Signature: Date: 9/28/01 The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments SYSTEM PASSES TITLE V INSPECTION.RECOMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. j ****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. i. yti 'r:41,. S r., ., r; ,, C..,-,,, fit C!�nnn 1 Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: SYSTEM PASSES TITLE V INSPECTION.RECOMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM USEFUL LIFE. 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. n/a The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a 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: n/a n/a 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: n/a Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. _ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance n/a r'F "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: n/a } 2 Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A . CERTIFICATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for alLinspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than''/Z day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped n/a. X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. <' _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] (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. ''y E. Large Systems: To be considered a large system the`system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply 4 '. X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yeg" in Section D above the Iage§y§teni hd§);ailed.The ewaer of operator of any loge§ystdm tansidaed d§ignifEditt 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. d Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X Were any of the system components pumped out in the previous two weeks? 1; X Has the system received normal flows in the previous two week period? X Have large volumes of water been introduced to the system recently or as part of this inspection? X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site? X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no X Existing information.For example,a plan at the Board of Health. x, X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] r� t' V I I 5 Page 6 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design):3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms):330 Number of current residents: 0 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no):NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use:(yes or no): NO Water meter readings,if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: 1131/01 COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sqft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no):NO >V Water meter readings,if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a GENERAL INFORMATION Pumping Records Source of information: n/a Was system pumped as part of the inspection(yes or no): NO If yes,volume pumped: n/agallons--How was quantity pumped determined?n/a , Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool m _Privy _Shared system(yes or no)(if yes,attach previous inspection records,if any) _Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a nH' •1'_i Approximate age of all components,date installed(if known)and source of information: SO YEARS OLD Were sewage odors detected when arriving at the site(yes or no): NO firs e. Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 BUILDING SEWER(locate on site plan) Depth below grade:22" Materials of construction:_cast iron X40 PVC other(explain): n/a Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) r Depth below grade: 16" . Material of construction: Xconcrete_metal_fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) ,ry Dimensions: 1000G L 8' 6"H 5'7"W 4' 10"" Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle:30" Scum thickness:3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): ;. THE SEPTIC TANK AND ALL COMPONENTS APPEAR TO BE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING NOW AND EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFUL LIFE SYSTEM. GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): n/a Page 8 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI a Date of Inspection: 9/28/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a 3 Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a DISTRIBUTION BOX:_(if present must be opened)(locate on site plan) , Depth of liquid level above outlet invert: n/a Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): NO BOX LOCATED PUMP CHAMBER:_(locate on site plan) } Pumps in working order(yes or no): NO Alarms in working order(yes or no):NO s Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): n/a u Page 9 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) , If SAS not located explain why: n/a Type . 1000 GAL 6'X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a n/a leaching fields, number: n/a n/a overflow cesspool, number: n/a n/a innovative/alternative system Type/name of technology: n/a . II Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH PIT IS STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. THE PIT HAS NOT HAD MORE THAN 2' OF WATER IN'IT.BOTTOM IS AT 8' CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): n/a ' PRIVY: (locate on site plan) ' Materials of construction: n/a Dimensions: n/a Depth of solids: n/a is Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): , n/a : s - •;`:tip' ti 4- il 1'f:. Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 02632 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 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. n6 AA 5l� f � r U � y3 `F Page 11 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 15 WASHINGTON BURSLEY CENTERVILLE,MA 026:32 Owner: C/O FRANK GRIMALDI Date of Inspection: 9/28/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12, feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record-If checked,date of design plan reviewed: n/a YES Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,installers-(attach documentation) NO Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: GROUNDWATER DETERMINED BY AUGER-NO WATER AT 12 FEET-BOTTOM OF PIT AT 8' P�a � 1a a AL012C AT ION S E A G E PERMIT N0, V 1- 'E INSTA LLER'S NAME & ADDRESS ► 1 -t:7 B U R D E R OR OWNER C V, At DATE PERMIT ISSUED DATE COMPLIANCE ISSUED M ��� �a ��. /7a /k� No ............... Fma.. ................. P/ THE COMMONWEALTH OF MASSACHUSETTS BOARD F HE ,A T ..OF..... ................ ........... .------................... Allpliration -fur Biiipviiat Workii Tnn,itrnrtion Prrutit Application is hereby'made for a Permit to Construct ( ) or Repair ( ) an Individual Sewa e isposai 14 �� � L System at: "Zjog �. AW ca' dres r o. ••--•- -- ---------------•-"'. ...... -.. •.......---•------------..................... -•--...... rGr .GII:_l%�iC 'e .c.....� !�- -5................... O ` � _� . Address Installer Address UType of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms--..--- ---------------------------Expansion Attic ( IC6 Garbage Grinder (Alk p, Other—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures W Design Flow............................................gallons per person per day. Total daily flow--------------------------------------------gallons. WSeptic Tank—Liquid capaciv 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 7e Percolation Test Results Performed by_----------------- ...................................................... Date---------------------------------- Test Pit No. I................minutes per inch Depth of "Pest Pit-------------------- Depth to ground water..--.-.-._.--.---.-....- (� Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water--------------------- Desc i tion of Soil .. .. .. . r 1� l - 0 � , � x ---------------�----- -- ------ -- -- ---- - ---- �- --------------------------------------------- U Nature of Repairs or Alterations—Answer when applicable...................----------------------------------------------------------------------------- -----------------------------------------•----------------------------------•-------------•-----------------••-•-----------------•------------•----------------- ------------------------------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned f tlier agrees not to place the system in operation until a Certificate of Compliance has been . ued by the boar of h lth. igned, ----• ----- •--- ••-•------------•----------------- 1----- -- Dat Application Approved By........ y v.- = ZZ.4" 7-��7 Date Application Disapproved for the following reasons:-------•--•-----•---------------•---.....----•-••------------•--•-------•--•-•----._...........-••-•...---••••. •---•------••-•-•-••••-•-_•--••••-----•--- •••--------------------------•-------------. Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS ,.--~ BOARD ,OF HEJA`fLTH ..v` .`.--._..OF...... Giis lrY .. r Appliration -fur BiBpwial Works Cnomilrurtion Prrtltit Application is hereby'made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: -------------------------------------------------------------•.... •-••••............-•-- ••--------•---•••--•-•-----......-••----•••••....................... Location—Address. --or Lot.No. a 4� Owner. t_—,.- ✓.) j Address ..-•-r--•---•-----•---•-•••---•--•••••••--•-•----^--^-----•-----------•--•--•--•----•--------- ------ `-- ....... ---•- --•--•-----•---.--------------•----•------------••--••--•••-••--•--- Installer Address UType of Building Size Lot---------_----------------Sq. feet Dwelling—No. of Bedrooms--------tea.............................Expansion Attic ( fr).v Garbage Grinder (A)16� `, Other—Type T e of Building ---------------_---------- No. of persons Showers — W YP g l '"_ - ( ) Cafeteria ( ) Other fixtures --------------------------------------------------- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity`.?..r-_---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 ( ) Oh- 9/y- 74 - '� Percolation Test Results Performed by------- ---------------•-------------••-•-.........----------••......•... Date...------------------------ ----------.. a Test Pit No. I----------------minutes per inch. Depth of "Pest Pit...------.---------- Depth to ground water.._................_.. f14 Test Pit No. 2----------------minutes per inch Depth of Test Pit.................... Depth to ground water.------------------. --. O _ ------ ----------------------�o---�/----- r------- Description of Soil---- ---------� �� -�- 7 i�f - , ------------ - .......� 1. '.-- rxc - ------ `�`-�.......=----- U Nature of Repairs or Alterations—Answer when applicable....-....................................................................................... ... -----•-----------•------------•--------------------------------------------------•----...----------...--------------------------------•-------------•------------------------------------- ------------ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. / igne f...- d- = .' -=1------------1 ..�`---:�------------ ' Application Approved B 1 Date i PP PP Y - ----- ------------------- GP Date Application Disapproved for the following reasons:-----------------------------------------------.-----------------............................................... -----•-----------------••--•----•-•-•-----•-••--......-------•-••---------••-••--•-••••---------------•..........---------------------------------------------------------- ----------------------_--- Date PermitNo......................................................... Issued........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS oBOARD OF HEALTH d` OF . ..................................................... Trrtifirate of f�1amplianre THIS S C "IFe,,' hat the Individual Sewage Disposal System constructed ( or Repairedby -----•------------------ ---------- ---- ------------------- ------------ ------ stiat.....-- -- ------ ..------ --- � .-••---�- J -� ... W has been installed in accordance with th¢provisions of A is of The S Sanitary Co/de as described_i the application for Disposal Works Construction Permit No... ....................`�. 3------ dated.......0 ...................................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT TIME SYSTEM WILL FUNCTION SATISFACTORY. DATE..G 19.7-17-------------- Inspector....... ..... ...&-jueez, -------------•--•-------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OFF HEALTH I .1...OF..............�'v.. .r................................ �rV No. -••--� //..••-• FEE..... - .......... inr�ttlrk Ctttrttrti�att Vrrmit Permission is hereby granted------------------------------------------------------- ---------••--- -------........1-------.--------------------------------............. to Construct ( ) or Repair ( ) an Individual Sewage Disposal System atNo........................................................................................................ Street as shown on the application for Disposal Works Construction Permit No--------------------- Dated--------.--------------------------------- r-� ------------------------------------------------------------------------------------------------------- - DATE--- / ............................... _ Board of Health FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS "7 vW5 (`t> 7v 5:Dmi-1 .1-o1 o1 aZ-)Sn 39 .svr� .l t`rb71-�ddd <rlr%or+S 5135.-l.:i0 =Dr+.L. :� -Lr`i7awr)WSt-m �SS�VYV o ���n�31so r+d ho n�5d8 ion Si r-�v�4 SIH1 521 o1,'a lea n5 o f'1`d'1 Q32i"3-►.519�2f 'ter► ��h � 2��.LX�'9 rJ �--_ ,�,.-r�� � � viva b6 �r.l. �o SlrtayY�?�tt�b�2! 7t7v�l�S ar�d 1°� �t`�to �a 1 S �t tl t-t1 t M Sl�-td Vvo7 Rtit� �l3r1 �7h3?d?--j3Z1 riv--tc1 t`t�T1S �to11�1at7�o,1 �1-f1 1`v'r1 1� t12t97 1 s?T1lh?a�llti7� t�eo11V7o'1 -. • ,. � .. 1ST l d NI w bb 7r9 oaoo! O LOCUS DATA DATUM: ---- 577� L-356��� CURRENT OWNER MARSHA MELE ! 2?•� ",' (� VERTICAL DATUM: BARNSTABLE GIS MSL± 151,9 ro.R R=25,p \ V PLAN REFERENCE 306-24 BENCH MARK USED: CORNER OF CONC. BULKHEAD x 2,5D "1, 0 DEED REFERENCE 17873-253 ELEVATION 60.50 CONCRETE 1 \� Z 60 \� � BOUNDS FND. \� ZONING DISTRICT RC OVERLAY DIST. NOT A ZONE II FLOOD ZONE "C" 250001 �.�.�,�°F ass LOT 98 ASSESSORS MAP 172 ��� EDWARD9c��m �ry 15,688f S.F. PARCEL 186 A. a STONE �.__.. ryo�' BPS ���� LOT AREA 15,688t S.F. ��T �No. 8 oa O \\ 35' 1 Ir.0 0 J / 21' GARAGE ` G� \ l �6'•• `� /— Od SITE 8c SEWAGE I ^`�!"��/ tc,= . , FAMILY / ROOM REPAIR PLAN 0v o CONC. 1PATIO LIVING O \ �. #15 WASHING TON 0 20 30 40 �° l) ROOM \ \ �` HURSLEY WAY KITCHEN _\ # IN GRAPHIC SCALE: % IT TING LEACHING BED 1 \ \ B A R N S TA B LE, MA 1 INCH = 20 FEET � / PIT TO BE EXISTING 1000 \ \ / PUMPED, _CRUSHED GALLON SEPTIC AT O ND\ i DATE: DECEMBER 6, 2010 O & ABANDONED IN TANK TO REMAIN AT BED#2 U `RE 1 OWNER/APPLICANT: 60 *14%� ACCORDANCE WITH I I I MARSHA MELE / TITLE= _ S BED#3 17' 15 WASHINGTONLn s Ln Ln co BURSLEY WAY 12'OAK I ' ° CENTERVILLE 138' MA 02632 �OJ, D.T.H. #2 $� 28" PINE ��i - -59- - �r �� ���`�� �� SHEET 1 OF 2 �' s � � �=�=I � PROPOSED� o OE ..L-L D� BOX �� PG�P uocus o N PREPARED BY: 11.5 � 32 D:T.H. #1 \ 17.7' E A S SURVEY, INC. �� s�� s�o ho 0o g1 141 R T. 6 A ; ems. �� o� 1 moo\ 0 P. O. B O X 1729 ors BENCHMARK: PROPOSED 24 \';� �` ♦�\F�' NORTHWEST CORNER OF M A 02563 "QUIK 4's" J F F2 ,��POF' \ CONCRETE AT BULKHEAD. 28 SANDWICH , C' G s ELEVATION 60.50 PH. (508) 888-3619 STANDARD PLUS CHAMBERS (H-10) LOCUS MAP CELL (508) 527-3600 \i l NOT TO SCALE: SYSTEM ®ESIGN RAISE COVERS TO WITHIN 6" OF FINISH GRADE SILL - $0.60 FINISH DESIGN FLOW H GRADE AL BEDROOMS AT 11 .Q GPB/D GPD "". F.G. ELEV, 60,20 ELEV, 59,70 a� FG 59,2 10 FG 58,8 REQUIRED SEPTIC TANK .� =-0 GAL, N 36 MAX, COVER OBS. SEPTIC TANK PROVIDED ® jAQQ--GAL, 24'®S= 0.035 4 ®3' S-0,03 TOP ELEV 56.33 PORNSA T s . „ EXISTING 4" PVC SCH 40 1 qt' S-0,015 ) SCH 40 INV.= 2 MIN-3 iV INV.= 57.85 57.27 10"TEE 14"TEE INV.= iv SIZE OF LEACHING FACILITY REQUIRED ,t- INSTALL GAS 57.10 T06 •� INSTAL BAFFLE/TEE /INV.= OUTLET DESIGN PERC RATE -_5L----MIN./INCH f: 4'-1" LIQUID LEVEL D-BOX 32' LONG TERM APPL. RATE-Q.74-GPD/S.F, ti SET "QUIK-4" STANDARD PLUS LEVEL c o SIZE OF LEACHING SYSTEM PROVIDED: INV.= 56.00 w a 330 _ 0.74 SF/GPD = _446 S.F. MIN. REQ. .26 USE (24) QUIK 4 STANDARD PLUSo e C eCHAMBERS H-10 TOTALING 96 LINEAR FEET in ELEV=55.33 EXISTING 1,000 GAL TANK TO REMAIN INV.= 56.09 48"x34"x12" STONELESS BED FORMATION in 'd TEST PIT # 1 ELEV 46.80 USING 24 STONELESS UNITS f ( THREE ROW OF EIGHT PANELS ) ADJ.' HIGH GROUNDWATER INFILTRATOR - 24 QUIK "4" STANDARD PLUS C 4.73 SF / LF X (4' x 24) = 454.08 S.F I CERTIFY THAT I AM CURRENTLY APPROVED BY THE OBSERVATION PORT ON END UNITS r 454.08 x 0.74 G/SF = 336 GPD DEPARTMENT OF ENVIRONMENTAL PROTECTION TO CONDUCT / SCREW CAP TO GRADE 336 GPD PROV > 330 GPD REQ. = 6 GPD RES. SOIL EVALUATIONS AND THAT THE RESULTS OF MY SOIL SITE 8c SEWAGE EVALUATION ARE OACCURATE AND IN ACCORDANCE WITH 310 SAND FILL NO (GARBAGE DISPOSAL / GRINDER ALLOWED) CMRM _' --- REPAIR PLAN EDWARD A. ST NE,__,CERTIFIE SOIL EVALUATOR o7' P#13143 #15 WASHING TON GENERAL NOTES: �-2.83'- -- -2.83'--4 -2.83'--+ D.T.H. #1 0 D.T.H. #2 B/ /p / c�/ �/ 1. ALL WORKMANSHIP AND MATERIALS SHALL CONFORM TO D.E.P. DATE: DEC 3, 2010 DATE: DEC 3, 2010 V/? SLL / WA / TITLE V AND THE TOWN OF BARNSTABLE RULES AND REGULATIONS GROUND ELEV. 58.8 GROUND ELEV. 59.1 N FOR SUBSURFACE DISPOSAL OF SEWERAGE. 8'5' NO GROUNDWATER NO GROUNDWATER END VIEW 2. AT LEAST ONE ACCESS POINT OVER TANK TEES SHALL BE T M A ACCESSIBLE WITHIN 6" OF FINISH GRADE, WITH ANY REMAINING A E A E BARNS ABLE " / / � ACCESS PORTS BROUGHT TO WITHIN 12 OF FINISH GRADE: LOAMY SAND LOAMY SAND ' DATE: DECEMBER 6, 2010 3. ALL COMPONENTS OF THE SANITARY SYSTEM SHALL BE 10YR 3/2 10YR 3/2 CAPABLE OF WITHSTANDING H-10 LOADING UNLESS THEY ARE 1OYR 5/1 10YR 5/1 OWNER/APPLICANT: UNDER OR WITHIN 10' OF DRIVES OR PARKING AREAS THEY DTH #1 INDICATES DEEP MUST WITHSTAND H-20 LOADING. TEST HOLE B 4" B 6" M A R S H A M E LE 4. THE EXCAVATION CONTRACTOR SHALL VERIFY THE LOCATION LOAMY SAND LOAMY SAND OF ALL UTILITIES PRIOR TO ANY EXCAVATION. 1OYR 5/6 10YR 5/6 15 WA S H I N G TO N 5. ANY MASONRY UNITS USED TO BRING COVERS TO GRADE „ OR WITHIN 6" OF GRADE SHALL BE MORTARED IN PLACE. INDICATES ELEV =57.0 22 ELEV =57.1 24 B U R S LE Y WAY 6. FINISH GRADE SHALL HAVE A MINIMUM OF 0.02 FEET PER P-1 54" PERC TEST FOOT OVER THE S.A.S. AND DISTRIBUTION BOX. ZHOFbL9ssq C C CEN TER VI LLE 7 SEPTIC SCHEDULE 40 0 SANITARY VCTAND SHALLSHALL E TENDEACM MINIMUM OFD6-FABOVE ����� DADVID c NO MOTTLING COARSE 02 5YE7/4ND COARSE 7/4ND MA 02632 THE FLOW LINE AND SHALL BE ON THE CENTERLINE AND 0 FEARER J NO GROUNDWATER 10% GRAVEL 10% GRAVEL LOCATED DIRECTLY UNDER THE CLEAN OUT MANHOLES. N 1 ENCOUNTERED 48 SHEET 2 OF 2 8. THE INLET PIPE INVERT ELEVATION SHALL BE NO LESS THAN, 2 INCHES NOR MORE THAN 3 INCHES ABOVE THE INVERT ' 'PF s NO G. WATER 144" NO G. WATER 144" ELEVATION OF THE OUTLET PIPE. ANITAR�PN �0' ELEV =46.8 ELEV = 47.1 PREPARED BY: 9. THE SEPTIC TANK SHALL HAVE A MINIMUM COVER OF 9 INCHES E A S SURVEY, INC. 10. THE OUTLET SANITARY TEE SHALL BE EQUIPPED WITH A GAS p B.O.H. BAFFLE, 4 INCHES IN DIAMETER AND CONSTRUCTED OF 4" PVC %`7/ I DAVE STANTON 11. ALL PIPES SHALL BE SCHEDULE 40 PVC SEWER PIPE AND SOIL EVALUATOR 141 R T. 6 A SHALL BE SLOPED 1/4 INCH PER FOOT MIN. EXCEPT FOR THE ' GROUNDWATER ADJUSTMENT ED. STONE FIRST TWO FEET OUT OF THE DISTRIBUTION BOX WHICH SHALL SOIL EV. LIC. APRIL, 1995 P. O. B 0 X 1729 BE LEVEL DEPTH TO BOTTOM OF HOLE 12.0' BACKHOE OPERATOR. 12. CHANGES OR REVISIONS TO SEPTIC DESIGN REQUIRE NOTIFICATION RODNEY FISHER SANDWICH M A 0 2 5 6 3 TO EAS SURVEY INC. FOR B.O.H. AND DESIGN ENGINEERS REVIEW SOIL TYPE: 1 AND APPROVAL, PERC RATE: <2 MIN. PER INCH PH. (508) 888-3619 13. MAGNETIC TAPE OVER ALL COMPONENTS. LOADING RATE: 0_74 GAL/SF/MIN CELL (508) 527-3600