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HomeMy WebLinkAbout0256 PHINNEY'S LANE - Health i riP rvlll � J eft - e A = 229 098 0 No. 42101/3 ORA ESSIEnrE 10% (* O O O O e i L i (`t1p,.k�—�d�� �� +. �� ,, 3 � ,, �=a - .� �� a �> �� No. O ` Fee (018) THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Ye PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS, f lPhratlon for Bisposar 6pstrm Construction i9Prmit Application for a Permit to Construct( ) Repair( ) Upgrade(A Abandon( ) Complete System ❑Individual Components Location Address or Lot No. 1 ��ACAWO bl 1� Owner's Name Address,and Tel.No. G c u1 f,� Cbf 2i57 rwN �Oa>G Tc o 6J t P1 c�S Assessor's Map/Parcel a a� ®g g (144 S f a AA R-009L 1--YAWN MA Installer's Name,Address,and Tel.No. ,502-4771-W`1'7 Designer's Name,Address,and Tel.No. Type of Building: Dwelling No.of Bedrooms LT Lot Size 030 -sq.ft. Garbage Grinder( ) Other Type of Building PES Lb NJTtA No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 4 4D gpd Design flow provided 4.5.5.-a, gpd Plan Date I -F-a+0l 8 Number of sheets O Revision Date Title Qj Z �'���!/! P B.4R--r al� Size of Septic Tank ` .5 CzI�{l, p d Dly( ."ype of S.A.S 3) 5 00 L "A04� Description of Soil - C 6T 6+ ( a- O% CT 1 / Nature of Repairs or Alterations(Answer when applicable) ;ilia-q.E_j �4-/® Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Heal . \ Signed Datef Application Approved by Date Application Disapproved by Date for the following reasons Permit No. Date Issued hA No. 1� 6A e t)U y - `` t►, w;..ufi Fee (N) _ �~ W THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: A PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ZIpplication for Bispie-al 6pstem Construction Permit Application for a°Permit to Construct( ) Repair( ) Upgrade( Abandon( ) [Complete System ❑Individual Components Location Address or Lot No. { 3%t4 gC"y*4fittVv`rii j j Owner's Name,Address,and Tel.No. G r� oo R(S'7 r,00 C0i✓e,GCV4-n a&J (N uS ,�Assessor's Map/Parcel ;t CI p :R �41 _ 7- a&* SL 4,,!y 6-f ,04 Installer's Name,Address,and Tel.No. _5®$,4'1 I•- 7-7 Designer's Name,Address,and Tel.No. j p$'-;P_73.03'1 y e_AP6,CAbt` .ate x"c Sr 'E 7.195 e_aA4-r_r ruin/ L4(eA E.L4_A " Type of Building: Dwelling No.of Bedrooms L4 Lot Size L %O 3 Q sq.ft. Garbage Grinder( ) r Other Type of Building 2ES r No.of Persons Showers Cafeteria Other Fixtures e Design Flow(min.required) (�'�, y gpd Design flow provided gpd Plan Date I -4ND j Number of sheets 1 Revision Date Title 7ti LM "f f e"A a 1 Size of Septic Tank. '50 y Gg4a4X�)( ype of S.A.S/1 5"Ue-) "L At:)� Description of Soil 'd w C l�SAS� � Nature of Repairs or Alterations(Answer when applicable) Y'NS7j ��/,� / (ScX� rr<tx� •(D .. -rfa &S 1-L--) 0—4v sc oar 44��� Sw??aF�y xh5!xJt� Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o Health. , Signed Date Application Approved by �-� �( �, Date Application Disapproved by - Date for the following reasons Permit No. A I? l q low`'! 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( )by (2APFA0(D& at , 1 :-;2 4 {/Q.LLG[,zrJ?';,{ RT) &V14.LE has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No /q,- -` tl dated l iP Installer 0AP&4 X bZ zyzb; , g&-N Designer _3C, 1c�7C,/A..)G ,XA_j C, #bedrooms Approved design flow 440 gpd I The issuance of this permit shall not be construed as a guarantee that the system wi112ifunctiowas designeil Date I 1 l ! (`a Inspector i r No. 0 � Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal. *pstem (Construction permit Permission is hereby granted to Construct( ) Repair( ) Upgrade( Abandon( ) System located at FA_t L{, a ;' j OA;D 6tr V I / e5- 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. i . j. Provided:Construction must be completed within three years of the date of this permit. Date ! it 1 Approved by f'�N(V'- /f it I F r �+ � , 01/17/2018 14 :46 5082730367 #5854 P. 001/001 Town of Barnstable ,.� Regulatory Services Richard V. Scali,Interim Director "MorAmz a Public Health Division eoNv+` Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 509-862-4644 Fax: 508-790-6304 Installer& Designer Certification Form Date: 1- 1-7"1 g Sewage Permit# 01'9- Assessor's Map\Parcel 22 9/ q8 Designer: 5 C. L-rl5trl eeCj ,Tor-. Installer: Cgecwide. er4*.Qri Se Address. 2e5q Gra0berrX W,6_wAY Address: 153 CCmmer0(0J S4fECf Eask wn(e,4►am� MA oz53 � H004�. e, H� o2 (ay9 On I l ( -aO t g r-4m,4& � +Qt f SeS was issued a permit to install a (date) (installer) septic stem at 13 S I ralvvWi+- t load Rke Z 8 based on a design drawn by p y (address) -SG &0 lrlg e4cin ci , TOG. dated �a�varr 9, ao1f3 (designer) V 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. .1 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 by designer to follow. Strip out (if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was construc rice with the terms of the IW approval letters(if applicable) f JOHN CMUR ILL JR. _ VIL ( stalle Sig q N .41 7 90 v s ZE igner's Si ure) (Af7ixigfi.66 s St mp Here) PL RE N TO BARNSTABLE PUBLIC HEAD IS N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOT IS FORM AND AS. BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THAN YOU. Q:1SepticOesigner Ccrtification Form Rev 8-14-13.doc 7 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owners Name information is required for every Centerville MA 02630 6-23-17 page. Cltyrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately 06- ! 3 rr ® Pr - '7 _8 t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Town of Barnstable P i 5S-7 d Departinont of Regulatory Services Barg Public Health Division Date Z (S MA89. rs39 200 Main Street,Hyannis MA 02601 Date Scheduled ' Ti'me Fee Pd._ Soil Suitability Assessment for Se e Disposaz Performed-By:,, H►fin"e l f WW'JrL( aT 1 'CSC t Witnessed By; LOCATION&.GENERAL INFORMATION I ocadon Address FA q 0 `ri p-0 Owner's Name �R f57-pj Xp 0 tiSC _n � Address (� tAV 5 T d tJ-o'�L LYl ivt A Assessor's Map/Parcel: • oZ��/ l(.��f C APC-Wr 1)� Bnglncer's Nama NEW CONSTRUCTION/ REPAIR Tolo hone# T 8�-27 3-G 37/ Land Use• 50Sci f_ ' afflI y' au'�1 j✓1 Q' Slopes(96) 2 Surface Stenos Distancos from: Open Water Body -' ft Possible Wot,Area ft Drinking Water Well ft Drelhago Way Property Line 7 ft Other ft SIKETCHC(Street name,dimensions of lot,exact locations of test holes&pare tests,locate wetlands In proximity, to holes) SeC_ Plw, Parent material(geologic) t)V kwa� Depth to Bedrook r Depth to Groundwater. Standing Water In Hole: + Weeping from Pit Face ^ ti Estimated Seasonal High Groundwater 7 � 3 2 y5 5 , a DETERMINATION FOR SEASONALHEGH WATER TABU Method Used: XecA- 6 05 e_,ryaticw 7 1 3 Z De lh Observed standing In obs.hole: In, Depth to sell mottles: In., Do th to weeping from side of obs.hole: In. Groundwater Adjustment tt. Index Well-t Reading bate: Index Well Imvol -� AdJ,•fhotbr, , r _Adj.Clroundwater•Leval PERCOLATION TEST bole Time �'► Observation Hole# Time at 9" Depth of Pere 3(0-y g " YB y Time at 6" Start Pro-soak Tlmo @ f' t ('S q�I`�`� Time(9"•6") r End Pro-soak (P JrZ•a.v� 12% d I �+^► Rate Mln./Inch . 2 2- Site Sul lability Assessment; Site Passed _ Site Failed: Additional Testing Needed(YIN) N Original: Public Health Division Observation Hole Data To Be Complated on Back ' ***If percolation test is to be conducted within 100' of wetland,you must first notify the Barnstable Conselrvation Division at least one(1)week prior to beginning. Q:ISEPTICIPBRCFORM.DOC DEEP.OBSERVATION HOLE LOG Hole# ( k 3 Depth from Sall Horizon Sall Texture Shcl Color Sall• Other Surface(in.) , (USDA) (Mansell) Mottling (Stnuetum,Stonm,Boulders. Car taletency, uraval) d l�Yr3h. U-3(o 5 lv`l'r -4 3(9- ►32- G ,�-C S 2�.5Y �/b Zola cJ41 5 ood cicat.,o DEEP OBSERVATION HOLE LOG Hole# Depth$om Soil Horizon Soil Texture Soil Color Soli Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. 36-l32 C �GS 21-:5, 15-2o% cis aoA Sraue,l DEEP OBSERVATION HOLE LOG Hole# Depth from Sail Horizon Soil Texture Sall Color Sall Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders, DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Sall Texture Sall Color Sall Other Surface(In.) (USDA) (Mansell) Mottling (Structure,Stones;Boulders, C i Flood Insurance Rate Map: Above 500 year Mood boundary No— Yes--Z. Within 500 year boundary No�Yes Within 100 year flood boundary No.✓ Yes pepth of NaturaUv Occurring Pervlotm Materl_al Does at least four feet of naturally occurring pervious material exist in all areas observed thrpughout the area proposed for the soil absorptibn system? ya If not what is the depth of naturally occurring pervious material?,,_.._._._.... .. . � P Cer'tlfication I certify that on ��^27�7 (date)I have,passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required training,expertise:,ndperlence described in 410 CMR 15.017. Signature Datti Q:%SRpTjWRRCPORM.DOC TOWN OF BAARNSTABLE r I LOCATION 13 ,�C.(0Q(%( "E Kl� SEWAGE# - (� ' "t VILLAGE (_4C-A _i!%UL ASSESSOR'S MAP&PARCEL Xa9l 9 a INSTALLER'S NAME&PHONE NO.CA4-49�AJeD Lt7tlScS 4F7��� �°� SEPTIC TANK CAPACITY ( 5(gyp RpS LEACHING FACILITY.(type)(M 5ooA etfA,1tgg&$ (size) NO.OF BEDROOMS OWNER !2t4A,1S'ztfj 6o1QC;AEC� QQ !U PERMIT DATE: t _((._-10 LIE COMPLIANCE DATE: ( - 1(®—P1 6 t 9 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) N Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) N/A Feet FURNISHED BY aC. EIKJTZAAL56S A e 28 a' Is•1 Z�•s, g-Z s Z 1 8-3 : 49.3 'IA-q 34 REAR A-5 • `is� 0 0 O O �1KE Town of Barnstable Barnstable Regulatory Services Department 1 a'cac j iARNSCAHM " . Public Health Division FDN4A�� 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 6186 July 31, 2017 CHRISTIAN CONGREGATION IN US 12 DAY ST - 2ND FLOOR LYNN, MA 01905 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1384 Falmouth Road, Centerville, MA was inspected on 06/23/2017 by James D. Sears, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Backup of sewage into the house due to an overloaded or clogged SAS or cesspool. The cover to the septic tank needs to be replaced immediately. You are ordered to repair or replace the septic system within sixty (60)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH �t-7omas McKean, R.S.�, C H- .Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1384 Falmouth Road Centerville.doc ' 1 , Town of Barnstable + �xr�srAacE, 6 ,,�� Regulatory Services Department ED Ml� Public Health Division 200 Main Street,Hyannis MA-02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5111116 DEADLINES TO'REPAIR FAILED.SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) _ An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground Y ' ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe: ?Packup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA q Single Cesspool- ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components, etc) o Leaching pit or cesspool with high liquid level, <12"below inlet(per Town Code §360-9.1) ❑Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER b�p S:nd� YwWj Repair deadline: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments CZ1, 9 p Y rY �`�" r` 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-170 page. City/Town State Zip Code Date of Inspection U 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 A. General Information S� /� olnlng the computer,out forms # ( q�( � H OF MgS��i���i ``���p ...... sgcy use only the tab 1. Inspector: key to move your JAMES U' cursor-do not James D.Sears =o' m—' use the return ? OE e oc—, �0 key. Name of Inspector Capewide Enterprises �,•.�'F ���.• Company Name 153 Commercial Street ���/st iNSp�G`\t` Company Address r Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 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 6-26-17 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 177 I t Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. CityrTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Failed system - Leaching. The system is a 1500 Gal. Tank D Box and three trenches. Note: Poly tank. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 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.doc•rev.6116 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in 921Q= is less than 6" below invert or available volume is less than '/2 day flow L E,-e/(I Al G t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 . I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy.is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. l5ins.doc•rev.6/16 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 ^M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town, State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth bf Massachusetts u W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ° M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and three trenches. Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage NA 9 ( Y 9 (gpd))� Detail: Sump pump? ❑ Yes ® No Last date of occupancy: NA 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth'of Massachusetts H Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town 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: NA Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth bf Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: 1996 Permit #96 -643. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 26" 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.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 15" 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: 1500 Gal. Poly Sludge depth: 2„ t5ins.doc-rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle Tank has been pumped. No usage sense. 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 How'were dimensions determined? Asbuilt-Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Note: Poly Tank-Tank has been pumped no useage. House being worked on. Note: Outlet cover of poly tank gone. Riser and cement cover in place. Not Safe. Sand falling into tank. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �nM 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Common wealth*of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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.): D Box is 16"x 16" -2' below grade w/three line's out. Wall are gone. Need to replace Box. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth'of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ® leaching trenches number, length: 3 ❑ 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.): Camera out lines. Leaching line's are blocked w/dirt and mud. Need to replace leaching. 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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 L . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of soil, signs of hydraulic failure, level of pohding, condition of vegetation, etc.): Privylocate on site plan): ( P ) Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts w - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �A 0 9. 13 r 7 -8 3 t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealtti of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells NU Estimated depth to high ground water: 12+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ® Observed site (abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: Abutting area 12'+ no G.W.. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 1 Commonwealth of Massachusetts N W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments �M 1384 Falmouth Road Property Address Christian Congregation of The United States Owner Owner's Name information is required for every Centerville MA 02630 6-23-17 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to AII'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.doc•rev.6/16 Title 5 Official Inspection Form:Subsurface Sewage Disposal System r Page 17 of 17 PLC Town of Barnstable BAMSTABLE. = Regulatory Services Department 9 MM%. g plf039. Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director... FAX: 508-790-6304 Thomas A.McKean,CHO June 25, 2007 Paul McDonald, Chief of Police Town of Barnstable Police Department 1300 Phinney's Lane Hyannis, MA 02601 Dear Chief McDonald, We are forwarding this letter to you. The dwelling at 1384 Falmouth Road, Centerville; was condemned on June 7, 2007. The Chairman of the Board is requesting your assistance in monitoring 1384 Falmouth Road to ensure no one lives or sleeps in this dwelling. Our Health staff will continue to monitor the situation during the weekdays. Sincerely, Thomas A. McKean Director Q:\WPFILES\1384 Falmouth Rd Police Chief2007.doc f �tHE Tp� town ®f Darnstable MASS R {ifNSIABiMG Y v� 6 . A,0$ Board ®f Health 200 Main Street, Hyannis MA 02601 Office: 503-362-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,DMD Junichi Sawayanagi Mr. Evandro D. DeCastro June 18, 2007 1384 Falmouth Road Centerville, MA 02632 •" NOTICE OF CONDEMNATION - FINDING THAT THIS DWELLING IS DEEMED UNINHABITABLE The property owned by you located at 1384 Falmouth Road, Centerville,' MA. was inspected on June 7, 2007 by Health Inspector Donald Desmarais, R.S. The following violations of the State Sanitary Code, 105 CMR 410.00, were observed: 105 CMR 410.830 (A) (6): No water provided. 105 CMR 410.830 (A) (6): No electricity provided. Persons were living in the house using candles at night. This dwelling was inspected previously on March 1, 2007 at 11:35 a.m. by Jeff Lauzon, Building Inspector, Martin McNeely, Fire Inspector, Robin Giangregorio, Building Division, Mark Delaney, Barnstable Police Department and Thomas McKean, Health Agent for the Town of Barnstable because of several complaints. At that time, the following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 were observed: 105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of nine (9) bedrooms observed in this dwelling. (Three bedrooms were observed on the main floor [NOTE: the living room appeared to be converted into a bedroom], three bedrooms observed on the second floor and three illegal sleeping rooms were observed in the basement). However, the existing septic system was designed for only three bedrooms total. It does not have sufficient capacity for the number of bedrooms observed in this dwelling 105 CMR 410.450: Three separate sleeping areas with beds observed within the basement without any second means of egress provided within each of these bedrooms. 105 CMR 410.401: The floor- to-ceiling height is less than seven feet throughout the entire basement. The floor-to-ceiling height is only 6.5 feet. 0AWl1FlL.F'S\DeCcastro I3S4FalmouthRoadBOHHEARIN(,.doc r i 1 105 CMR 410.482: No operational smoke`detectors provided throughout the dwelling. Section 170-10: No carbon monoxide detectors observed within the dwelling. 105 CMR 410.481 - Posting of Name of Owner—Rental property is not posted with owner's name, address and telephone number. 170-4- Certificate of Registration —Property is not registered with the Board of Health as a rental property. Occupant stated rent is being paid and is deposited into a local bank. A hearing was scheduled to be held on March 21, 2007. However, you failed to appear before the Board of Health at any of that hearing scheduled on Wednesday March 21, 2007. A hearing was scheduled on May 22, 2007. However, you failed to appear at that hearting also. Finally on June 12, 2007, the Board voted to uphold the emergency condemnation and order to vacate issued on June 8, 2007. In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human, and based on the results of the inspections conducted on June 8, 2007 and March 1, 2007, the Barnstable Board of Health determines that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.000, the Board of Health further determines that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Based upon these findings any and all occupants are hereby ordered to vacate. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated he may be forcibly removed by the local Board of Health (Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Notot This is an iniportant le al document. It may affect your ri hts. yayne i D. BO OF HEALTH TOWN OF BARNSTABLE CC: Police Chief MacDonald Q:\WPF f L,ESU.)eCcastro 1384 FahnouthRoadBOH HEARING.doe e - Page 2 of 9 II. Hearing (New): Evandro DeCastro — 1384 Falmouth Road,-Cenferville—reg-arding-re-c ring housing violations including overcrowding and insufficient septic system capacity. Mr. McKean spoke of the site visit. It appears even without basement bedrooms, it has always been a five bedroom. The prior owner was sited for violations and two years ago they did rip out bedrooms and take down walls. They sold property. The septic still needs repairs. The current owner is out of the area through April. Upon a motion duly made by Dr. Canniff, seconded by Ms. Rask, the Board voted to continue until May 22, 2007 Board of Health meeting. (Unanimously voted in favor.) III. Variance Request (Cont.): POSTPONED Catherine Morey, Coastal Engineering Company, representing Silvia & UNTIL Silvia, 116 Scudder Avenue, Barnstable, 1.3 acre lot - Proposed house APR 17, 2007 addition, five variances requested. IV. Variance Request (New): A. David Crispin, P.E., P.L.S., BSC Group representing Dr. Nathan Rudman, 40 Waterman Farm Road, Centerville, 18.2 acre lot, new construction, six bedrooms proposed, multiple variances requested in regards to setbacks to wetlands and coastal bank. Norman Hayes spoke. The property is 17 acres and they are only installing one septic system. David Crispin presented data. They are not crossing any creeks on property. There is bordering vegetation wetlands (BVW) and coastal wetlands. They have installed at least nine monitoring wells to monitor water flow direction. They have all uniformed soil, thus all the water will flow to salt marsh. The town coastal bank is 71 feet away and is wooded. It is 67 feet to the BVW but with the water flowing to salt bank, the flow would be 150 feet from salt bank. They would like to install a bathroom in the barn, thus, one line would run to the left going out to the barn. Mr. Hayes said the nitrogen loading is 1.5 mil. per liter which is well below the recommended and this would be a fully compliant Title V with the setback variance. On 9/11/06, they did a high watermark test and are well over 100 feet from that. Reserve area requires setback variance from Town ordinance (not state), as well. The property is 5.7 feet from ground water. Soil testing has been done in the right side of property where the system would normally be located. Soil test must be done in the area of the proposed septic. Sue Rask would like them to supply the geologist readings. Dr. Miller had concern of the accuracy of flow due to the space between the monitoring wells by the far right wetlands (-100+ feet) Michael Cronin, neighbor, asked to have Mr. Crispin to identify the location of house on the assessor's map he brought. He thought the location is where the old cranberry bog was located. On 6/07/2007 at approximately 8:15 PM Officer Kevin Donovan, Building Inspector Jack LeBoeuf, Zoning Enforcement Officer Robin Giangreggorio, and myself Health Inspector Donald Desmarais RS arrived at 1384 Falmouth Rd., Centerville. We had stopped so we could find Evandro DeCastro (the owner of the property) to talk to him about the conditions. Upon arrival the front side door was open and ajar. There were people in the basement apparently trying to turn on the water in the house. There was no electric turned on in the house either. Upon further investigation I discovered three bedrooms and a kitchen in the basement. Two bedrooms on the first floor and three bedrooms on the second floor. There was at least one person living in the house. Without running water and no electricity (he was using a candle for light) I was compelled to condemn the property until such time as there is running water and electricity. I IN XI ZI Ft ra,, Town of Barnstable Regulatory Services ■ BARNSrABLE• MASS. Thomas F. Geiler,Director 1639• �0 039 Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 June 8, 2007 Evandro DeCastro 1384 Falmouth Road Centerville, MA.02632 EMERGENCY CONDEMNATION AND ORDER TO VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter II: Minimum Standards of Fitness for Human, Donald Desmarais RS, Health Inspector for the Town of Barnstable, on June 7, 2007, conducted an inspection of the dwelling located at 1384 Falmouth Road, Centerville, Massachusetts. The owner's name in this dwelling is Evandro DeCastro. Based on the results of that inspection, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.000, the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling, which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 830 (A) (6): Termination or failure to restore promptly water, hot water, heat, electricity or gas There was no electricity or running water in the premises. Persons were living in the house using candles at night. Q:\Order Letters\Condemnations\l 3 84 Falmouth Road.doc e l Based upon these findings any and all occupants are hereby ordered to vacate. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated he may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Note: This is an important legal document. It may affect your rights. Signed Cc: Evandro DeCastro, Owner Mr. Tom Perry, Building Commissioner Chief John Farrington, COMM#1 Fire Department Robert Smith, Town Attorney Chief Macdonald, Barnstable Police Chief Q:\Order Letters\Condemnations\13 84 Falmouth Road.doc . P�oFt"ETOwti Town of Barnstable 2-2-9-0 99 * * Regulatory Services * BARNSTABLE, MASS. 1639• Public Health Division �p ♦0 ATFD MAC s 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health March 1, 2007 Mr. Evandro D. DeCastro 1384 Falmouth Road Centerville, MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE CHAPTER 2, 105 CMR 410.00, THE STATE ENVIRONMENTAL CODE, TITLE 5 The property owned by you located at 13.84 Falmouth Road, Centerville, MA. was inspected on March 1, 2007 at 11:35 a.m. by Jeff Lauzon, Building Inspector, Martin McNeely, Fire Inspector, Robin Giangregorio, Building Division, Mark Delaney, Barnstable Police Department and Thomas McKean, Health Agent for the Town of Barnstable because of several complaints. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code, Title 5 were observed: 105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of nine (9) bedrooms observed in this dwelling. (Three bedrooms were observed on the main floor [NOTE: the living room appeared to be converted into a bedroom], three bedrooms observed on the second floor and three illegal sleeping rooms were observed in the basement). However, the existing septic system was designed for only three bedrooms total. It does not have sufficient capacity for the number of bedrooms observed in this dwelling 105 CMR 410.450: Three separate sleeping areas with beds observed within the basement without any second means of egress provided within each of these bedrooms. 105 CMR 410.401: The floor- to-ceiling height is less than seven feet throughout the entire basement. The floor-to-ceiling height is only 6.5 feet. 105 CMR 410.482: No operational smoke detectors provided throughout the dwelling. Section 170-10: No carbon monoxide detectors observed within the dwelling. 105 CMR 410.481 - Posting of Name of Owner—Rental property is not posted with owner's name, address and telephone number. 170-4- Certificate of Registration—Property is not registered with the Board of Health as a rental property. Occupant stated rent is being paid and is deposited into a local bank. You are ordered to provide operational smoke detectors within or adjacent to each bedroom, within 24 hours of your receipt of this notice. You are ordered to remove all mattresses and to remove all beds from basement and from the living room before March 9, 2007. You are ordered to remove all doors to each of the three private rooms located within the basement before March 9, 2007. You are ordered to remove walls or partially remove walls in order to provide minimum five feet wide openings to each room in the basement before March 9, 2007: You are ordered to install carbon monoxide detectors on every habitable floor before March 9, 2007 You are also ordered to submit a complete application for registration (for rental property) and to enclose the required fee of$90.00 to register the rental property with the Health Division at 200 Main Street, Hyannis before March 9, 2007. In addition to removing the above listed four bedrooms from the basement and living-room, you are ordered to either (a) remove two additional bedrooms from the dwelling or (b) you have the option of upgrading the septic system to accommodate a total of five bedrooms observed on the first and second floors within thirty (30) days of your receipt of this letter. You are scheduled to appear before the Board of Health at the public meeting on Wednesday March 21, 2007 at 3:00 p.m. The hearing will be held at the Town Hall, 367 Main Street, Hyannis, Massachusetts. Non-compliance will result in the issuance of non-criminal ticket citations of $100.00 each. Each day's failure to comply with an order shall constitute a separate violation. .7 PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean Director of Public Health CERTIFIED MAIL # 7006 0810 0000 3524 8660 1 � 'PORM30 I-I&W HOBBS&WARREN'"' THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH CITY/TOWN o DEPARTMENT C-2-0n MCI 'o ADDRESS G,,M Svb y`0W TELEPHONE Address13B " F41"11DIZ�_(2c4_ _ Occupant_M Ur SoiomI aw �;AlyL Floor--Apartment No.— __ No. of Occupants CO21A0 77�p9p`� -3?6� No. of Habitable Rooms ~7 No.Sleeping Rooms`j_______ �� No.dwelling or rooming units tn1_ No. St les Name and address of owner_EVe,1_a_C0 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.: No SeclM As 0 s ,a,; ❑ B ❑ F ❑ M Doors,Windows: vj-, ;,, d o rem ;� S Roof Obcervc ; 62sr,P� Gutters, Drains: Walls: -; r- _ ,2 et k- W/ Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ro L-flr7 900 ❑ MS ❑ ST ❑ P Waste Line: H.W.Tanks Safet a d Vent s o ELECTRICAL Panels, Meters,Cir.: 13110 ❑ 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 iJ r_o a M CC)N1 w Bedroom 1 -�0 d,r , „� 1�10 �� r��Q, r S ro Bedroom 2 Bedroom 3 Bedroom 4 Hot Water Facil. 1-70 Stacks, Flues,Vents,Safeties: w-b1„ , G3 d c1 Kitchen Facilities Sink Stove Bathing,Toilet Facil. Vent., Plumb.,Sanit'n.: c) Wash Basin,Shower or Tub: Infestation Rats, Mice, Roaches or Other: Egress Dual and Obst'n: WnQt S nay pti«ne ^ate A-(,p y 7 General Building Posted o 1-70 /a Locks on Doors: No a a one Sma e c rS 2 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY."INSPECTOR _ !n nS mL� TITLE 0-*a4�0r Or 4c'Ct A.M. DATE TIME _ f/y` P.M. THE NEXT SCHEDULED REINSPECTION MOA(-CPA C) 2 oo-7 fed P.M. M+ t. ..� ,;F r � �...'�'�+xF{rr„•.^,�:r"�'':!�lf% ' 4�...,p.« p r..s�- :.+.�:..y.:v. �t"n`^ M;'a;w•*y ��f, "v7i'�jy.;,- ,''r.'�+.I+'..,.� Y.-..,.v,. ,,,r•..,ry f 410.750: Conditions Deemed to Endanger or Impair Health or Safety The following conditions, when found to exist in residential premises, shali be deemed conditions which may endanger or impair the heaith, 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 II, 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. (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. DIME ti Town of Barnstable o� Department of Health, Safety, and Environmental Services * BARNSTABLE, MASS.16.19. Public Health Division prF�'A°�A 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health - April 29,2005 Mr.Valter Pereira Dasilva Mr. Joel Coelho 1384 Falmouth Road Centerville,MA 02632 NOTICE TO ABATE VIOLATIONS OF THE STATE SANITARY CODE,CHAPTER 2, 105 CMR 410.00,THE STATE ENVIRONMENTAL CODE,TITLE 5 The property owned by you located at 1384 Falmouth Road, Centerville, MA. was inspected on April 29, 2005 at 11:05 a.m. by Jack Fitzgerald,Building Inspector, Martin McNeely,Fire Inspector, Sergeant Sean Sweeney, Barnstable Police Department and Thomas McKean, Health Agent for the Town of Barnstable because of several complaints. The following violations of the State Sanitary Code, 105 CMR 410.00, 310 CMR 15.000 State Environmental Code,Title 5 were observed: 105 CMR 410.300 and 310 CMR 15.00: Inadequate septic system capacity: There were a total of ten(10)bedrooms observed in this dwelling. (Three bedrooms were observed on the main floor [NOTE: the living room appeared to be converted into a bedroom], three bedrooms observed on the second floor and four illegal sleeping areas observed in the basement). However, the existing septic system was designed for only three bedrooms total. It does not have sufficient capacity for the number of bedrooms observed in this dwelling 105 CMR 410.450: Four separate sleeping areas with beds observed within the basement withoutJOW any second means of egress provided within each of these bedrooms. <a"16 Sto." 105 CMR 410.401: The floor- to-ceiling height is less than seven feet throughout the entire basement. The floor-to-ceiling height is only 6.5 feet. 105 CMR 410.482: No operational smoke detectors provided throughout the dwelling. 6n, ', " `i 105 CMR 410.481: Pile of broken furniture and debris observed on the ground behind dwelling rrCUYI (behind rear deck). t 105 CMR 410.481: Pile of old abandoned mattresses observed on the ground behind the fence and several tires on the ground.. �' 105 CMR 410.481: Many cans of paints, paint thinner, and other paint supplies on the ground behind the dwelling. Gle 105 CMR 410.500: Exposed wiring and piping in the ceiling of the kitchen. A section of ceiling approximately 3 feet by five feet was missing from the kitchen. You are ordered to provide operational smoke detectors within the dwelling, within or adjacent to each bedroom,within 24 hours of your receipt of this notice. You are ordered to remove the four illegal bedrooms from the basement by removing all of the beds and by removing all of the partition walls separating the sleeping areas from the remainder of the basement, within thirty (30) days of your receipt of this letter.. e F r` You are also ordered to remove three additional bedrooms from the dwelling or you have the option of upgrading h p pg g the septic system to accommodate a total of six bedrooms observed on the first and second floors within thirty (30) days of your receipt of this letter. In additional,you are ordered to remove all of the broken furniture, old mattresses, tires and other discarded debris from the property within thirty (30) days of your receipt of this letter. You may request a hearing before the Board of Health if written petition requesting same is received within seven(7)days after the date the order is served. Non-compliance will result in the issuance of non-criminal ticket citations of$100.00 each. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF BOARD OF HEALTH as A. McKean Director of Public Health i FORM30 H&W HOBBSBWARRENIM THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH CITY/TOWN W R4 Ic- a DEPARTMENT fyl ADDRESS '' 22 �rr / l TELEPHONE Address �q �WObt-Cl�l �o�ol ��— upant—, ^ .S'Cal ZeV' Floor Apartment No. No. of Occupants No. of Habitable Rooms No.Sleeping Rooms ' No. dwelling or rooming units_ No. Stories Name and address of owner_va_ pref -a �' h Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish- , f„ C Containers: �1 Drainage Infestation Rats or other: � r t� STRUCTURE EXT. Steps,Stairs, Porches: �rc& c ��A ep Q, Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: Roof ,, i�I I n I�N J Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Lighting: STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: ` Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N E ui . Repair TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: roflMS ,� r� 7� !` o0 H.W.Tanks Safet and Vents 0 vj ef- "c S 6 ELECTRICAL Panels, Meters,Cir.: 1,6 s g- ❑ 110 ❑ 220 Fusing,Grnd.: AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring: DWELLING UNIT Ventil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchen oa, 1 ©a Bathroom 42; Pant " r^ Den Living Room Lvq S AA✓ ow, c.s jS C.,,z rn- tyou- Bedroom 1 . b a Qwe-a X i -4v— 1. 9 01, to �/O Bedroom 2 G Bedroom 3 x LAJ ,y, Bedroom 4 y Q, 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: 0 SecOn o ress P-Dvi General Building Posted tuo 0 a s ei0 qkz 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OFPERJURY." � j INSPECTOR ` �a �G s I�'1�✓ ar� TITLE -dr- 0--1 L V, 7 DATE �'( I Z�1 D� I J.Q --A A TIME 1 . yS AP.M. A.M. THE NEXT SCHEDULED REINSPECTION '30 �f-_S P.M. I 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 Ieadbased 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. (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 CM•R 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. y t , 'M 30 CHW HOBBS&WARREN rn THE COMMONWEALTH OF MASSAC'HUSETTS FORM BOARD.[ F HEALTH r— y CITY/TOWN o DEPARTMENT Sv=� Ao F(P-2 jj,(0 ADDRESS U ,f n ll00 TELEPHONE Address__�S' -F�1W10v IGt 1C c pant �v l _`fie _SCdl ZGr Floor Apartment No.- ___ _ No.of Occupants No. of Habitable Rooms__-_.__ _ No.Sleeping Rooms 'No. dwelling or rooming units___ No.Stories Name and address of owner-�a.l�/_�/�'era L 15,1 lva_ Remarks Reg. Vio. YARD Out Bld s.: Fences: Garbage and Rubbish- Containers: SItI �IA �( �� by ' j Drainage dtclo - Infestation Rats or other: , 0-�_ a 6%j W X "AqLdA qr, tY STRUCTURE EXT. Steps,Stairs, Porches: -.}i[C s on 1-11J&A 66,� te�N cr Dual Egress:and Obst'n.: ❑ B ❑ F ❑ M Doors,Windows: --IAA" c„t S O "As y Roof J n f 1Int Gutters, Drains: Walls: Foundation: Chimney: BASEMENT Gen.Sanitation: Dampness: Stairs: Li htin : STRUCTURE INT. Hall,Stairway: Obst'n.: Hall, Floor,Wall,Ceiling: Hall Lighting: Hall Windows: HEATING Chimneys: Central ❑ Y ❑ N Equip. Repair r TYPE: Stacks, Flues,Vents: PLUMBING: Supply Line: ❑ MS ❑ ST ❑ P Waste Line: d j �,•�� a,b r, UJ l�n y/ oo H.W.Tank s Safet and Vents. 0 wtVrs r P 'c 'S S ELECTRICAL Panels, Meters, Cir.: 1,s rQ,4 { ❑ 110 ❑ 220 Fusing, Grnd.: ,,, 8o �,tg -a b Ott AMP: Gen. Cond. Distrib. Box: Gen. Basement Wiring,,--- DWELLING UNIT V.entil. L to . Outlets Walls Ceils. Wind. Doors Floors Locks Kitchenolo Bathroom Pantry rin Jn I. C �a� �' Cn,lenc, ri Den J Living Room-- W in}v lac Jp om , Q, Pa (. _�(SF�►^ G GpaC .����� a Bedroom 1 y , C t�n r1 �cn/P �p_r -',1 Q'i 0n1d 44IU �/O Bedroom 2 � .0 -E rn`ja�, f hG_- , _`'i Bedroom 3 X Wl� Bedroom 4) 6S: ,1Ve 1 Hot Water Facil. Sup.Ten.,Gas, Oil, Elect.: Stacks, Flues,Vents,Safeties: Kitchen Facilities Sink .t Stove I f. Bathing, Toilet Facil. Vent., Plumb.,Sanit'n.: �; Wash Basin,Shower or Tub: L Infestation Rats, Mice, Roaches or Other„ '» Egress Dual and Obst'n: W CAtOACk haaAS o 2 ress P-DvAi ar if beb,n„ ',^ 4i 4P50 General Building Posted / , ® a a( ,& w Yw z 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 REPORT IS SIGNED AND CERTIFIED UNDER THE PAINS AND PENALTIES OF PERJURY." ) INSPECTOR�O rAO S me kY�an TITLE DATE LI 29 05 1 ),(5 i4nn �A�IIh TIME . (Z� — P.M. A.M. THE NEXT SCHEDULED REINSPECTION `�U T;, 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. (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 MASSACHUSE,rrs EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS v DEPARTMENT OF ENVIRONMENTAL PROTECTION v W d 1 h Q C OW ip^M Syev TITLE 5 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner's Name: TERRY DEYOUNG Owner's Address: BOX 196 RENSSELEARVILLE NY 12147 Date of Inspection: 6/12/01 Name of Inspector: (please print) JOHN GRACI Company Name: SEPTIC INSPECTIONS Mailing Address: P.O. BOX 2119 TEATICKET, MA.02536 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 systeiti: X Passes _ Conditionally Passes _ Needs Fu r Evaluation by the Local Approving Authority Fails Inspector's Signature: �I Date: 6/12/01 The system inspector shall subm' 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 appl owing authority. Notes and Comments ; THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE HE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. 4 ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE, MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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: THE SYSTEM PASSES TITLE V INSPECTION. RECOMMEND PUMPING THE SYSTEM EVERY TWO YEARS FOR PROPER MAINTENANCE. 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 thIan 41imes 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 Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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 "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 froni that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pprn,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 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all-inspections: Yes No 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 '/2 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 nLa. 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 pis 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. 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—I W PA)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 "ye§" in Section D above the large§y§t@lii lia§failed:The owner or operator of any large§y§lem non§idered a§ignifit alit 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. • a IPage5 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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? X _ Has the system received normal flows in the previous two week period`? X Have large volumes of water been introduced to the system recently or as part of this inspection ? X _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected for signs of sewage back up? X _ Was the site inspected for signs of break out? X _ Were all system components,excluding the SAS, located on site X _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] t Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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: 1 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: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CMR 15.203): n/agpd Basis of design flow(seats/persons/sgft,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: 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 _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: 1996 Were sewage odors detected when arriving at the site(yes or no): NO 6 Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property ert Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" 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) Depth below grade: 12" Material of construction:_concrete_metal_fiberglass_polyethylene other(explain)PLASTIC 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: 150OG L 10' 6" H 5' 6" W 5' 8"" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 0" 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: n/a 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 ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL 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 a 7 Page 8 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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: X(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: LEVEL WITH BOTTOM OF PIPE Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): DISTRIBUTION BOX IS STRUCTURALLY SOUND 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 Q Page 9 of 1 I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 SOIL ABSORPTION SYSTEM (SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type n/a leaching pits, number: n/a n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a n/a leaching trenches, number, length: n/a 2 leaching fields, number: 30'X 4' X2' 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 TRENCHES APPEAR TO BE FUNCTIONING PROPERLY-SYSTEM SHOWS NO SIGNS OF FAILURE. 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 0 Page 10 of l l OFFICIAL INSPECTION FORM SYSTEM INSPECTION FORM FR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISpOSAL PART C SYSTEM INFORMATION(continued) Property Address: 1384 FALMOUTH RD.CENTERVILLE,MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of inspection: 6/12/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Prov ide 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. ptdt A q (o ga C AA $1 Ab?y 8 AC al eA 1 0 6�e� in "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: 1384 FALMOUTH RD.CENTERVILLE, MA 02632 M229 P098 Owner: TERRY DEYOUNG Date of Inspection: 6/12/01 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 NO 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) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: USGS MAPS AND CHARTS- 12+FEET t t � % Town of Barnstable Department of Health, Safety, and Environmental Services B,tMASSems. I MASS. Public Health Division .P i639. � Eo� 367 Main Street, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean FAX: 508-775-3344 Director of Public Health January 23, 1996 Berkley Savings& Trust 1675 Palm Beach Lakes Blvd. West Palm Beach, FLA 33401 ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 1384 Rt. 28, Centerville was inspected on December 12, 1995 by Charles Merricam a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Back-up of sewerage due to hydraulic failure of all three cesspools. You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A McKean, R.S., C.H.O. Agent of the Board of Health [Installer letter] sl T0: ORDER TO COMPLY WITH 310 CMR 15.00, THE STATE ENVIRONMENTAL CODE, TITLE 5. ,��U`�' ' The septic system owned by you located at / �' '� was inspected on Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: R3 Z, r;�o;A"14 & ,-4 " --,e V-�f��You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office (Town Hall, 367 main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (14) fourteen days of receipt of this notice. You are also directed to bring the septic system into compliance within thirty (30) days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided.for by the laws of the Commonwealth. PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean,R.S., C.H.O. Agent of the Board of Health Town of Barnstable �� �� � � ���� I . 4 1 ' I • Commonweatthl,loft Massachusetts.,lt,1+.1 Executive Office of Environmental'Affairs ®epartment'`'o�'?) �� I� 4.3111LI„;..; e DEC ,2 IEnvironanentcal Protection William F.Weld ate ;, Ar +rit ,tasl Iry ra.t11 6 Governor , Trudy CoXe . , . `rt�..4 1 "�:f `:•',(2 CA David B. Struhs Arm Commissioner ,1fJ !T;' { 1"Yi,+,tr •(;.1.1,? fl+'j:"� 6 , hr "^ fie SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A _ CERTIFICATION Property Address: '> , Address of Owner: ,n n (If different) Date of Inspection: Name of Inspector: c'l-{�/ r `�(_ S )dl'� h t�m it:,, I(�-7 . �R(�tM 'r4 Cl"�.,L,t��� l3 L Compan Name, Ad(Iress td Telep n Nymb �: ,. /� 1"ti 1 4 y�y. i.S WF(,.LC( e[f� 1.,�!C.(,� '.. Lb r P A�-,m O J5AC(� FL'fr��} a c.' 6,/'4 •'L=, 3 A Ic'Dt(-,L�f� t VYW rr , � t, ! J� 7 0 CERTIFICATION STATEMENTC��'' I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ;il I L".i rj,':t� ?I I Passes l•rus,w r. tr i , ir Conditionally Passes ^ Needs Further Evaluation By the Local Approving Authority .t �'"rd115 ,, r , ;r,', 1 .,6H Vj .:f'1 a! ,`i 'i. TZ` ie 11 .IA]iIL' .a«1'i; f;.. ;Ct '•,°1 .5,iir'r ;I)11HrV11 Inspector's Signature: Date: i ',Yttob•r '+• G (,/,��Kv/ .•'7" ✓ , '•'t„:U {;il}i ltc D .._ i N ryr( "1 10(1"t�, r The System Inspector shall submit a c py of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is.a shared system or has a design flow of 10,000 gpd or greater, the inspector`and the system�owner shall submit rx, the report to the appropriate regional office of the.Department of Environmental Protection.; +1 3".11.f`." 1l'i"• 1 1 ?. i ..' s The original should be sent to the system owner-and copies sent to the buyer, if applicable and the approving authority. . is + ,� " i 11 '�, ,",i 'ii , 1 t'• .t li' I"W, V;rP� i'f1•.i:. INSPECTION SUMMARY: ;',; ;:.• 'r�tr:Y. :a •i .,> IY lL, " 1 II• •p. .1 " t �(.: ^fr''" '11A, :p, _ ' . .i.! . :� " ,'i I+d1)r"�/. '+I1 ..,... Check A, B, C, o D i ! - ' ' ,1 I •" r It A' •I , Irua t ,t i!t .. •. • ,>?-,. ". •_ , A] SYSTEM PASSES:A 1 have not found any information which+indicates that the system violatesany of the failure criteria as defined in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. B] SYSTEM CONDITIONALLY PASSES: r One or more system components need to be replaced or,repaired. The system, upon completion of the replacement or repair,, - passes inspection. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not)" I _ The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failtse is imminent. The system will pass inspection,if the existing septic tank.is replaced with a conforming.septic.tank as approved by the Board of Health. (revised 8/15/95) One Winter Street • Boston,Massachusetts 02108 • ' FAX(617)SWI049 • Telephone(617)2t12-5500 ` Printed on Recycled Paper ii..:,. .,Ir I" SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ,- r yy l ry C:IL.1 PART Tlf'! iv 1 '(3 :1.�• l-..I �.)`afiFaiw, t� la.> ,� 0{fG�i. r'� l�I�i.� , CERTIFICATION (continued) ,, S Property Address:`l ��L��- ors( C Ir ,y , . Er c ? i a p � r•� �,11,tr'I,' w7.i tla,`Ys..� i� f' w i "� Owner: 13 C)�k 1. ' l �' �' L'"� "1/�'f� *rn-C) Date of Inspection- { B] SYSTEM CONDITIONALLY PASSES (continued) aV I � SIB � , � �ri'•ISF;" ,• ,>P1.u9'S _ ag�'k eekbreakout or high static water level observed in the distribution box is due to broken or obstructed pipes) o�, roken, settled or uneven distribution box. The system will pass inspection if(with approval of the ea broken pipe(s) are replaced -I' S obstruction s removed distribution i box is levelled or replaced , t;l,h Oh I I':,+, : .I 1'. y a .1 C.It. �wall I', 'y'1. ' I _ The system required pumping more-than lour times a year due to broken or obstructed pipe(s). The system will pass,l it,., m: inspection if(with approval of the Board of Health): + °�'"' r"I: It.l )I,t• !tJl,.i rrne.d.l a1�r. ') P PP ) .Ir1 broken pipes) are replaced ' 1' obstruction is removed t •Ti h. 71. !r.1. C ,. uiC1i) �'a.lri1. •t. •+rl<+CII +rtft n)rY :r! 111 t-"14 t'1, �,N . „r'r'�,.IT!'iC !3rr,'7 11r11 r i •,. .)hi.irr,.l') II:I'. C) FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: r' '""'i ''1S 'rtl°"'i' +'. ;:ct,:;,r !T;;i;r+=;r x:'11 11:1111yf'�111­,r•+'rl ` Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. d '•,! r,•I,ItI,,.,_) , 1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING` 1 A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND 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. f , �,. r ld.`. ;I,1„+, I'1 � ';I' )t I 1 U; )•.. , •, ,. 1•, it aidt I! {If.'! dI II rn•J771,) r.r 2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF-APPROPRIATE) DETERMINES THAT"-ia•+ THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT-THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT •rl „ '7 ,IS • T l . I r.,.; r , ,i, it 1: t.i:ae Pr. !IL b,nr;111u ",1" The system has a septic tank and soil absorption system and is within 100 feet to a surface water supply or tributary to a surface water supply. i •r,h�,r,1 ,"4_)I t:J'u9 "i The system has a septic tank and soil absorption system.and is within a Zone I of a public water supply well. k _ The system has a septic tank and soil absorption system and is within 50 feet of'a private water supply well. _ The system has a septic tank and soil absorption system and is less than 100 feet but 50 feet or more from a private water { supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the'well.iilt(e. i,i free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than.5,- ppm• ! r, ,, 1 .. ,�, ,� �!•�'•rt (I'll rill of!:I'"t,uin, trri, I.t 'I'll illI,.alfYrli D] SYSTEM F S: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be'contacted'to�determine what will be necessary to correct the failure. rlulrnul,a,. , rr! . I 1 `-1 Backu of'sewage into facility or'system component'due`to an'overloaded•or cI' ed SAS or cesspool1 •£''Y 17 +, {+•'.sa;n u � �.i� o �..� Ou• 0 A 60 fw W LET Discharge or ponding of effluent to the surface of the ground or'surface'waters due to an overloaded or clogged SAS or cesspool. S' (revleed 6/15/95) 2 ' t� I' gin .-1 r '1 GI Ir �iFp ��6�•;c! ��'lili)�d.� +A Ifrlt�s„i dad°.9::Sai1:`:,{'...I'' ,fld:t9;Irtd' .l iC:,",'�: 'I''..�'f.1''t(,� • p r+ y r SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM , PART A _ ll CERTIFICATION (continued) Property Address: ! / C Owner: 1'l✓ L 'G�i C 6 7 AL Date of Inspection: 1 j r "Ae 0/s - DI SYSTEM FAILS (continued Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SASAor cesspool. Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/2 day flow. _ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s)• Number of times pumped (, ti .,n�?, ..,, :,, u , ,r, e'•'�� , Any portion of the Soil Absorption System, cesspool or privy is below the•high grourtOwater_elevation. ,+r11r Any portion of a 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 I of.a public well. or 1' i:•', _ 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. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. E)URGE SYSTEM FAILS: ;r+ The following criteria apply to large systems in addition to the criteria above: „ . .�.a The design flow of system is 10,000 gpd or greater (large System)and the system is a significant threat to public stealth and safety and the environment because one or more of the following conditions exist: 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 11 of a public water supply well) , The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program ° requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. I p , I 1 1 (revised 8/15/95) 3 , l SUBSURFACE`SEWAGE DISPOSAL SYSTEM ONSPECTION FORM',":); r - PART B'"'I "CHECKLIST'I'll '00I01 I I /(/� Property Address: 9L'T1G�l F .L• E t i ni,,;i n Owner: S k4e.6�j2u 9 [�C,pK ��,E.� .�V rt.rt'. ` .iie.iiriifraa"i} �'��':.f.l. '':i`:•' +r..! Date of Inspection '+ r i ' :t7 l,. : t rv�':�t i.r 1 ai• Check if the following ha_ve been done: L—Pumping information was requested of the owner, occupant, and Board of Health. �-<o a of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. i r r r X11AAs built plans have been obtained and examined. Note if they are not available with N/A. - Zesycstern hility o dwelling was inspected for signs of sewage back-up.does not receive non-sanitary or industrial waste flow � (�Ct in 0 rir „'s; _The was in s ed for signs of breakout. _All system components, excluding the Soil Absorption System, have been located on the site. —The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for,condition of baffles on tees, material of construction, dimensions, depth of liquid, depth of sludge, depth of scum. _�.� .3,r••, r ..t ,Jll�r'!1 , ,. it. fit 1 �1lL1 r i f ,.i !Hl-_'+� r" ;I lid, �r•1'I The a size and location of the Soil Absorption System on the site has been determined based on-existing'information or approximat by non-intrusive methods. �� ; ,I • . , -I i i, • +i'r,, rr !. tn•i "n,^tILI , _The facility owner (and occupants, if different from owner) were provided'with information on the proper maintenance of Sub- Surface Disposal System. N It, ! r ,I )r,r ,, r.•1 f r � '1 i ri iri r t. •r,' ..t. t,l ter )' •r Ptr. c: r .t r i ( _ rn,., i (revised 9/15/95) .4 I I - t SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PARTC-7,..,i,'• : _ SYSTEM INFORMATION Property Address: Owner: l�_ —( P-4j jy , Date of Inspection: FLOW CONDITIONS _ :twi lr: rtr t.t RESIDENTIAL Design flow: Ygallo Number of bedrooms: �;' "•,.t,). Number of current residents: M / Garbage grinder(yes or no): �) ( -s Laundry connected to system (yes or no):-Q Seasonal use (yes or no): Water meter readings, if available: l 3 i ! 91 /i > i /� ._ .... t ;tl , ;?' ., t;r r .tir. , •e,,l� ,1 .. � ' '':t.l4t�. Last date of occupancy: /--7i� � !`I' COMMERCIAUINDUSTRIAL: Type of establishment: Design flow:_gallons/day J ,t tl. t;.;w r .:r.! ,, > ';I,•.,r•t 7:r1 rti, t. I:tlrl, Grease trap present: (yes or no)__ 4 ), ,, w Industrial Waste Holding Tank present: (yes or no)� Non-sanitary waste discharged to the Title 5 system: (yes or no)_ Water meter readings, if available: "_' - .__ - � •, •, -�•• _ ,-.... _... • • Last date of occupancy: OTHER: (Describe) D+r Last date of occupancy: t - GENERAL INFORMATION PUMPING RECORDS oo ation: tr 'r ` System pumped as part of inspection: (yes or no) r' T. If yes, volume pumped: allons _ Reason for pumping: "j�' 1�f1 lLyDi/rt.P .J �'- .5 �OZ� L B /'Lt.l v /=.�C%Yvp Ct/y1 —g TYPE OF SYSTEM ( Septic tank/distribution box/soil absorption system [___... Its cesspool Overflow cesspool f Privy I' Shared system (yes or no) (if yes, attach previous inspection records, if any) I Other (explain) APPROXIMATE A E of all compon its date installed (if known) and source of information: J{�u �� 60"CEO A7- l Sewage odors detected when arriving at the site: (yes or no).�•(� 5 (revised 8/15/95) i i ,•!a p Ill'. 1!+'r' a. +, n p . ' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ` ' "'PARTCa i" 4tYr, SYSTEM INFORMATION (continued) ( t . , r ,,• Property Address: 1, 'J'c� EiQ Owner: ��Cl �tC L �/ YlQ"��/ rf"[) Date of Irl�pectpon: I ` SEPTIC TANK:_ (locate on site plan) ' Depth below grade: Material of construction: concrete metal _FRP —other(explain) } •�tl n,.,' �; :. „�'� l '.,, Dimensions: Sludge depth: _....,...... .! Distance from top of sludge to bottom of outlet tee or baffle: 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: Comments: _�.___ ... . .. . :. . .__. •:n , t.•F ir.p n, `• (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert, atructural ,II integrity, evidence of leakage, etc.) ! '' 10 t „ GREASE TRAP: (locate on site plan) K;. Depth below grade:,_ •(p a,v iu +plt it Material of construction: _concrete _metal _FRP—other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: ' ,tpl ' " '' •t' ��+' '''('` x °p^Ip pt^ : Distance from bottom of scum to bottom of outlet tee or baffle: - — - Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation Ito outlet invert, structural integrity, evidence of leakage, etc.) fie . tt ..t• !i rt�»p ,,. ,. r„ t I t; rl,hta�.Y t 6 I(Ievised 8/15/95) a 1 I { SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM ., ! PART,C , _ SYSTEM INFORMATION (continued) ., Property Address: I Owner: CI /L�y'�S C/11L' > [ `1 ' s/_ r' Date of Inspection: :eua t• ,al lr,t n�,U r� TIGHT OR HOEDING TANK: 691 lip 'VI-01 :t i r Y.t Ir3'11.. .'t, !r. •.1 .tint od Its-+,1!ay, i+ I+ Cat.,, •f.5+•1 ,ti4flrtl; ('t ,1, .t .a r•,, 'i,. . ', (locate on site plan) Depth below grade: Material of construction: _concrete _metal ,___FRP—other(explain) - ! Dimensions: Aid Capacity: gallons Design_ flow: t allons/day Alarm level: ! Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_ r ,• (locate on site plan) 1 , Depth of liquid level above outlet invert: --- ---- ,•• -. --•- {.. .+U l,.r ! ' d 1„',' 1 1r Comments: (not)el if level and distribution is equal, evidence of solids carryover, evidence of leakage into or outof box, etc.) PUMP CHAMBER_ `;'' n �" ;:'• il+,, b{rt 1t� ;x,:i1 , r,, ;, '. ;., ; .u• 1 <sr:;r;a,r.r i (locate on site plan) - -•--•'._ _ ._.._ ' Pumps in working order:(yes or no) Comments:. (note condition of pump chamber, condition of pumps and appurtenances, etc.) i ,,a. I � ! (revised 8/15/95) ] . 1 ,e I � • 1 �I`�Nr� ��1j1.(fi dhi4 b�W 11't.l A1WIeAiiIUJWu,Wlu u,,neiNai4"uri , u•.µi.,u.+p.. .r...,,�•u«,h ......_.�_..........,..... ,.•.....+......... ...... a �� �i� •� f'1� I I ' � � � ,.,xwt.. •.. ..� +a.,,.,,y,r r.M.. ........«.....w+�+•y+-».«.._.- .......f,....._.,._......,..»......».�_._-.»... ii" I SUBSURFACE SEWAGEtDISPUSAL SYSTEM INSPE(TI'ON FORM J' PART'C . ��yy • SYSTEM INFORMATION (continued)' t� Property Address: V. ^�.r6�� t ' )tr Ica t��l:!I,1 ,1 r Owner: 13v I✓ � L//it•�f.��' /QK� �I ( °� *,,.,;�; Date of I pection: ry 4wy ri 1!) {1 SOIL ABSORPTION SYSTEM (SAS):_ (locate on site plan, if possible; excavation not required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: _ leaching pits, number:_ leaching chambers, number._ _.._ ..,„._.. f�•„r t .:;,,f.? leaching galleries, number: 1"s leaching trenches, number length: leaching fields, number, dimensions: overflow cesspool, number: •Comments: (note condition of soil, signs of hydraulic failure, level of pond ing,'condition of vegetation,etc.) )'t CESSPOOLS: _ (locate on site plan) Number and configuration: - C tj It f"/L 0 P_I1 C A-( Depth-top of liquid to inlet invert: — Depth of solids layer: CT Depth of scum layer: , Dimensions of cesspool: Materials of construction: C.L7W�,�...t�-�_= 5 ..�^,+if tie , Indication-of groundwater. _ t, r n rto w inflow (cesspool must be pumped as part of inspection)_ t y'w� j Comments: note condition of soil signs of�iydrauliq failure level of pondin , condition of vegetati n, etc.) / �'�5 o I' r l,tCt L PRIVY:_ (locate on site plan) ..vy-�.. ,. �. ,� �r i tl I"' +' h 4.,!'I ,p"tflL'1 1•.� - ,,i. r:.. ,f. Materials of construction: - Dimensions:— Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) E ' (revised 8/15/95) B e; SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM E _. PART C SYSTEM INFORMATION (continued) Property Address- Owner. `Date of Inspection: SKETCH OF SEWAGE DISPOSAL SYSTEM: , include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' I I 77 t O t 4 �1 DEPTH TO GROUNDWATER i Depth to groundwater: feet enn n U G n �` method of determination or approximation:_�� . _�, ,t �S (') ���t-%1�.(�i�`j l C� ') o A-;T-r-4 � r t (revised 8/15/95) ' .9 it I IJ.II ilY.1�•IIrYJxJuY r{u.U.41Y.a/lurµf Y�,JNIxM..{4,.I..�I.KY..11111. .,a-..�,r,w a xrxwlw-«..,.r..�....�.,.w........w.y«,y y�,�al.-+s.wu..irr.r.x...�. �.«.,�.«s,.. .N.,.,.�..yw«�._� .HaIrWl9WWI141rl1411I Illlrlgor�Irlll ilWl tO I Ir s No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE., MASSACHUSETTS 2pprication for Miopozaf *potem Construction Vermit Application for a Permit to Construct( )Repair( 4pgrade04bandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. `s � CC�X-, Owner's Name,Address and Tel.No. I �+ < � CO Agr�A 6-e Assessor's Map/Parcel ®—L I Installer's Name,Address,and Tel.No. Rev-f Designer's Name,Address and Tel.No. V t, R ca-0 Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures � Design Flow gallons per day. Calculated daily flow �3-7) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank���(� S"�' Type of S.A.S. Description of Soil 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 E onmental Code and n to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo f H alth. Sign _ Date Application Approved by ZZ Date Application Disapproved for the following reasons Permit No. (714 t% Date Issued of r Nb Fee THE COMMONWEALTH OF—MASSACHUSETTS Entered in computer: - es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLES MASSACHUSETTS 4 Tipprication for Migogar *potem Cow5truction permit _ Application for a Permit to Construct( )Repair Grade Abandon( ) O Complete System El Individual Components ` Location Address or Lot No. Owner's Name,Address and Tel.No. Assessor's Map/Parcel, . \.!t 1� aa�= o qf Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms 3 Lot Size sq. ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow `1 gallons per day. Calculated daily flow �3_3-e—�) gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank '� C Type of S.A.S. Description of Soil ; 9" Nature of Repairs or Alterations(Answer when applicable) �---�--tom►. I�� '-'2n�T��"'�✓r�c.� C , Date last inspected: Agreement: ,a . 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 E tonmental Code and no•to place the system in operation until a Certifi- cate of Compliance has been issued by this Bo . H alth. Signe Date Application Approved by .Date Application Disapproved for the following reasons r Permit No. DateIssued ———— ——=— —— —`'———————— ————————————— THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, MASSACHUSETTS Certificate of- Compliance f THIS IS TO CERTIFY, that the On-site Sewage Disposal System Constructed( )Repaired Upgraded Abandoned( )by `a ' at L S has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. ",:;'dated 12 — ('"`'"9 al. Installer Designer The issuance of t1irpermit shall not be construed as a guarantee that the sy a '11 function as ned Date �.��-+ l/�� Inspec---------------------------------------- No. — L i Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLES MASSACHUSETTS Mi-gpo5al *p5tem Con.5truction Permit Permission is hereby granted to Construct( )Re air( rade( )Abandon( ) System located at L i and as describedih the above Application for Disposal System Construction Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided: Construction must be completed within three years of the date of this permit. Date: ) 7 -- . a/_ Approved by NOTICE: This Form Is To Be Used For the Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT ()YITHOUT DESIGNED PLANS) hereby certify that the application for disposal works construction permit signed by me dated /c;? ' �,� , concerning the property located at i-7FY �/ ��C� �-(' meets all of the following criteria: • There are no wetlands within 300 feet of the proposed septic system • There are no private wells within 150 feet of the proposed septic system • The observed groundwater table is 14 feet or greater below the bottom of the leaching facility • There is no increase in flow and/or change in use proposed • There are no variances requested or needed. SIGNED : DATE: LICENSED SEPTI SYSTEM INST LL IN THE TOWN OF BARNSTABLE NUMBER [Attach a sketch plan of the proposed system.Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. q:health folder:cert 1 r I TOWN OF BARNSTABLE LOCATION 138,q A1mcu16► Cat dB ) SEWAGE# :':; II:LAGE C�e/t7 t!�✓/�l ASSESSOR'S MAP&LOTgZ INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY %S'D D PA It, I AN k 1 — (size) �X y "X oZ AGILITY: c7 T2ev' 64, �n �ACHIN GF ) ALE type h A G E :'f4o.OF BEDROOMS DER OR OWNER 4-0.tf.4- //L// =/ ?. eje7 PERMTf DATE: COMPLIANCE DATE:_ I� Separation Distance Between the: :1Vlaimum Adjusted Groundwater Table and Bottom of Leaching Facility Feet . vate Water Supply Well and Leaching Facility (If any wells exist Feet on site or within 200 feet of leaching facility) Edge of Wetland and Leaching Facility(If any wetlands exist . within 300 feet ifle hin facility) � Feet Furnished by / �`� r- - i77 Tpot IF� �� ******************************************************************************** * .User name : SAADD (86) Queue : BOA/HEALTH HP4MPLUS * File name : Server: HEALTH_HP4MPLUS_PSERVER * Directory: * Description: Saad Dale Daily View * January 10, 1997 12 :47pm * * * _ SSS A A DDDD DDDD * S S A A A A D D D D * S A A A A D D D D * SSS A A A A D D D D * S AAAAA AAAAA D D D D * S S A A A A D D D D * SSS A A A A DDDD DDDD * * * * * ******************************************************************************** * * * L SSS TTTTT * L S S T * L S T * L SSS T * L S T * L S S T * LLLLL SSS T * * * * * ******************************************************************************** QIr1t TOWN OF BARNSTABLE LOCATION 3 ► � '� SEWA& # VILLAGE t" n e—ity�'/`e ASSESSOR'S MAP & LOT S 9'"d INSTALLER'S NAME&PHON-NO. ✓��/� �.fl e_S P,�t1 e ??�" SEPTIC TANK CAPACITY %S©t� IO t 1 - 1 AA3�C LEACHING FACILITY: (type)oP (size) �x X NO.OF BEDROOMS`' DER OR OWNER ea PERMTTDA',t-E:` COMPLIANCE DATE: /6)'/10 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility. Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet off hing facility -- — Feet Furnished by ✓'� �� o Azle le • N���� �raY C R i O ® �'1 AOC T�POFFDUNDATOM = �1� 7'f f-F|N|3H �RADE �VERD��X= ^13'9'f F|N\SHGRADEOV�RCHA�BER� ` ������' - ���.�/ rN�������� �� U � I��-�P:�� i ' '~' ' -------� - ~�- ----- PROVIDE EXTENSION RISER GLOpE6� 296K8}N OVER 3M^ TD1-1/2^ DOUBLE VVASHED VNTH (�{)VEROVER INLET & RE0OyABLEyyATER_T|GHT 'COVER OVER ^, 3TOWN[ TO CROWN DFp|pE l UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISHED GRADE OUTLET TD WITHIN 8^OFFGGRADE 4^ SCHEDULE 4OPVC INSPECTION PORT WITH ACCESS METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL 45.8' / STONE OR GEOTEXTILE FILTER FABRIC CODE AND ANY APPLICABLE LOCAL RULES. 20"MIN. ACCESS 1 9 2, ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE COVER (3 TYP.) 9" MIN. PLACE RISERS ON ALL DESIGN ENGINEER. PROP. ~~'' -~ 4O7M MIN, TOP OF SAS=41 .33' ^''"'^'"�``� ,"'''' 3 4'' SCHEDULE 4O PVC PIPE V@THVVATERTIGHT J0NT8SHALL BE USED |NO|GPC>SAL PYC ��VY�M '� — 40 36 � ETPF�ST{) SEWER ^ ' " "' SYSTE/NUNLEGOOTHERVNS� NOTE� FINISHED GRADE 61, MIN 4. TO PREVENT BREAKOUT -THE PROPOSED FINISHED GRADE SHALL NOT 8E LESS THAN ' - -- - WATERTIGHT ELEVATION = 41OO' FOR A DISTANCE OF 15' AROUND THE PERIMETER OF THE SAS. UNLESS A 13 4OK8|LGEOK8E/NBRANEL|NER !SPLACEATLEAGTF}VEFEETFR0K4SASANDTHETOPOF | SEPTIC TANK % 4" PVC OUT TO 3� | THE LINER |S NOT LESS THAN THE BREAKOUT ELEVATION. LEACHING FACILITY rc / 5. SL(}PEALL S(]L|DPIPE AT 1O9& K8|N|K4U�� ^�1 <���`42.00'-j ALL TEES MUST A / / �� THIS QYSTEK8 |G NOT DESIGNED FOR A GARBAGE O|SPOSAL "^ BE CENTERED TEE ~����-' MIN �W��� 2' - 7� L(]CALBOARD{}FHE/\LTH AND DESIGN ENGINEER TC) BE NOTIFIED PR}[�RTOBA��N RISERS ty' C�RUGHEDSTONE F|LL|N[� VVHENSYSTEKA |8 NEARLY COK8PLETEAND READY FOR |N8PECT|ON GYGTEK� |S S8AFFLE / OVER } - __�_ NC�TTOBEBA{�K FILLED VV\THC)UTFIRST OBTAINING APPR(]VALFROK8BOARD OFHEALTH COMPACTED | 11O' OFFSETTOFNO ---- ����������� ---� � - �-- - -- | | | AND DESIGN ENG(NEER | x� i | . ° OUTLET / ------- 8 ELEVAT0NSBASED ON APPROXIMATE K8SLOATU/N. BENCHMARK ELEVATION OF45NI 6 CRUSHED STONE TDBE INSTALLED ONA LEVEL STABLE ' (TYp ) ESTABLISHED ON NAIL SET |N17'' OAK TREE AGSHOVVN0NPLAN. OVERKAE{�MECHANICALLY BASE. F/�STTVVOFEETOFOUTLET -- - / GROUND "� �� U�� | COMPACTED BASE \)L/�L/ \�L�yJ \)L/�L/ \�i/0�� PIPES TDBE LAID LEyEL �_ ���� ��F\' 1283' �� S C{�NTRACTDRSHALL VERIFY ALL UTILITY LC)CAT|DN3PR0RT[> CONGTRUCT0N ���/��(����� 1 �M� GALLON ��(��������l�� ���T��� T�hJ� ~~'~~ ' / � PROPOSED~�^�^-^^ ` `=~'" ^�~�" °~�' ~^- ^ ^- SEPTIC ' ~`'"^` -----'- ' 5' K�|N ~/ �����1h������� X����� �yV���� THR{)UGHD|G-S/\FEATLEAST72HOURSPR|ORT000k�K8ENCINGVVORKONS|TEAT ����r���� ����`T�(��J `�|�U� � ��n GALLON �� 1� ������������ ° -- CHAMBER ,�= ^� � | � ��rJ��-��� 8V1F�lF�� F�����7-�� (Dimensions per ~�. ^^�~�`� SECTION.~�^~ VIEW ^,( ~'-~^wv ' '- ^v' CHAMBERS "- VIEW 1'888'D|G'SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES | ^-�-`��� ` ^ ' -���-�� WIDTH^ ' -�e--��- DEPTH^ ' ��-��- ACK8E-GHOREY} i, �-�^�������t �����&�������� PROFILE TO THE OE3|(3N ENGINEER �� � K� ��������0�� �� �� ��0�� �����-���A� `' ' ` ` ^~~^ ^~- ~°' ^' `'~~~~-` ` ^ ` ^~~^ ^^-^- �� � �� ���� �� �A������ �������� �V KU� k �� SEPTIC'' ' `� `~' -` ' ���v��K- UK~[ ��� U �� ' ` -~'~' r- ' "° ' NOT | 10 ALL JOINTS VVHEREPIPE ENTERS AND EXITS CONC STRUCTURES SHALL BE MADE VVATERT\GHT NOT T[> SCALE NOT TO SCALE - — 11 NODETERKA|NAT|ON HAS BEEN K8ADEASTOCOMPL�NCEVNTH DEEDED UF�ZONING | NOTES: ~ « ^«o�"z� '' n�� TEST» PIT' -« » �� REGULATIONS. OWNER/APPLICANT |8TO <)BTA|NSUCH DETERMINATION FROM / ��K ' | PERC NO. 155�U APPROPRIATE AUTHORITY. °~ / � SEPTIC SYSTEM COMPONENT 1.) ' INSPECTOR: 12. ALL SEPTIC GY8TEK8 CONYP(]NENT8SH/\LLVNTHSTAND H'1OLOAD|N(3 UNLESS LOCATED ' » Great EVALUATOR K4iohae/ �imnnUei EiT CSE UNDER MORE THAN 3 FEET OF COVER OR LOCATED UNDER PAVEK�ENT. DRIVES, OR -------------'--- TRAVELEOVV�YS |N WHICH CASE THEYSHALLVV|THST�NDH'20L0AO|N(� 2.) CONTRACTOR SHALL vcn/r , ou.L Cu/vu/ //uno /^v THE L`/C,�'/v., `/. '..E ~ y ��� ��' �t� C S E APPROVAL DATE Oo� 1QQQ ''`°,""ED LE"`~' '''`" ^^ ^'E= TO ENSURE CONSISTENCY ,^'''' 'E"' PIT DATASHOWN ON THIS PLAN, REPORT TO ENGINEER AND LOCAL. BOARD OF HEALTHI IF 13 DOUBLE WASHED SHALL 8E FREE DIRT, DUST AND FINES DAT� �anuar . SOILS ARE NOT�^umS/S/Ew/ vv//H TES/ r// u*/* TEST p\T# 1 & 3 14 WHERE RE{JU|RED, CONTRACTOR SHALL REK8OVEALLLOAK�. SUBSOIL AND UNSUITABLE Benchmark ` ~�, _ __---__-_- 1 MATERIAL IN AREA BENEATH AND FOR 5 FT ON ALL SIDES C)FLEACHING FACILITY. � / ELEVTDP = �) ENTIRE rmu*�,�/ / /� �u�.�/�u OUTSIDE �n� �/�m/�� ur * ucr /~rrnuvcu �u`~c -- REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, AND ESTUARINE WATERSHEDS. - ELEVyyATER = � 335O' F|NES {}R {)THER UNSU|TABLE N1ATER|AL |NACCQRDAN��EVV|TH31O[�K�R 15255(3) \ ' Approx. M.S.4.) SWING TIES SHOWN ON THIS PLAN ARE PROVIDED ONLY AS A COURTESY FOR THE �J_ �� PER[� RATE = « 2 mm�/inuh 15. CONTRACTOR SHALL NOTIFY DESIGN ENC�|NEER {}FANY DISCREPANCIES FOUND IN INSTALLER. INSTALLER SHALL VERIFY SWING TIE MEASUREMENTS IN THE FIELD SITE [��]ND|T|{}NS FR{�K8THOSE SHOWN PRIOR T[) CONTINUATION {)F VVORN ENGINEER |F � LOC DEPTH OF PERC = ��' -46y' ( PRIOR TO INSTALLING- THE SYSTEM. CONTRACTORSHALL�LL 16. PR{}PO8EOPR[)JECTI8 LQCATEDVNTH|N� ' MEASUREMENTS APPEAR TO BE INCORRECT. C7 � TEXTURAL (�L8SS � ASSESSOR'S MAP 228 LOT 98 ~/^ 50 MAP 229 OWNER OF RECDRD CHR/ST|ANCON6REGAT|ON IN THE UNITED STATES O'' 44.57 ADDRESS. DAY ET FLOOR Fill LYNN MA 01905 - , 1f/' 43.17' -` `' A FBNA FLOOD ZONE X 2O^ 428�y COMMUNITY PANEL# 0 Loamy Sand 17 DEED REFERENCE: BOC�K22S4Q. PAGE32 5"TRIPLE B 18. PLAN REFERENCES: 1 PLAN BOOK 109, PAGE 105 | 2 PLAN BOOK 38B. PAGEQ0 3S'' 41 5O' � 3.) PLAN 8D{)K625. PAGE 87 ~ 4 ) 1931 STATE H!GHVVAYLAY{}UTND 2748 '° ~�°x� . ' 4Ey' 4050' 1S A4.' PERFORATED 3CH 40 PVC PIPE SHALL BE PLACED |NA VERTICAL POSITION TOARESER PROPOSED INSPECTION PORT � � ° v v \~ - � / DEPTH OF THE BOTTOM OF THE SAS AND EXTEND TO WITHIN 3^ {)F FINISH GRADE A _ REMOVABLE THREADED CAP SHALL BE PLACED ON THE TOP TDALLDVVFOR INSPECTIONS. - - . / �� V�� ~�O- ��n�* y�� 7U� ' � `' 20 PROPERTY LINE }NFORMATI()N !S ONLY APPROXIMATE. THIS PLAN IS TO BE USED ONLY ^'^��~~° , �~"- �-� °~v��`~ t°u��«/� 1'� �� � ,.°����� �� \�`��' (15-20% cobbles FOR SEPTIC SYSTEM UPGRADE. J{� EN8\NEER|N{�VNLL NOT ASSUME ANY LIABILITY FOR USES {�F THIS PLAN OTHER THAN ITS INTENDED PURPOSE. � | 0 0 \—PROPOSED 3-500 GALLON �13 LOCUS �~���� U �� PLAN 21 OVVNER/ApPL|(�ANT / C{�NTRACTOR SHALL BE RESPONSIBLE TD OBTAIN ANY AND ALL U K �K °K 8��� M~~U ��k��� LEACHING CHAMBERS WITH 0);;_, ���� �~ �� �� " ��° �° � REQUIRED PERKA|TS/\NDAPPRC�VALS FOR THIS PROJECT. SCALE� 1'' = 1OOU' 132'' 3350' NoyWo�m0, StandmgurVVeemng (}boemed ~/ DISTRIBUTION BOX AmF- '---- ----- -------' i | ' GARAGE �-������ ��U�~ �� ��~�.� LEGEND ����������0 K~� J�~��� U ���� U PIT ���~� U �� K������,���V"� DATA TOF=487± L. SEPTIC TANK 01 PERC NO. 15570 ------ 58x0 EXISTING SPOT GRADE (NSPECTOR� Donald DayI�a�mFRS__ NUkA8ER {)FBEDROOK8S (EX|GT|NG) 3L / EVALUATOR: K� E CSEEXISTING PVC -- -- 5D -- - EXISTING CONTOUR �&��U� ����K� NUK8BER C�F BED�C���KAS (D�G|��N) �� �� C�S�E� APPROVAL DATE� Oct� 1SAS ��� p�Op{}8EO SPOT GRADE `�.,`" "-u_~, LOTg87DWELLING DESIGN FLOW 110 GAL/DAY/BEDROOM DATE January5 2018 50 �^� PROPOSED CONTOUR TOTAL DESIGN FLC}VV 440 GAUDAY TEST PIT#� 2 &4 ~~-� 46 EXISTING OVERHEAD WIRES DESIGN FLOW x 200 '� = GAU0AY ELEV TOP = 46 USE PROPOSED 1,500 GALLON SEPTIC TANK ELEVVVATER = / 33 �O EX|�:T|NG GAS LINE SWING-TIES SCALE S(�ALE = 1..=20. PERC RATE = =° °'' °~� , '^-~' // _~ -~� ----------------- EX!ST|NGVVATER LINE / \ DEPTH {}FPERC = DESCRIPTIONINSTALL � ��� GALLON /����0�������c� / ��T��hJ�� ----�------� ,.��� . . ^._.- ~. - ^^"`, CHAMBERS`.�.`^°_, .^, V�, STONE�^.�`_ �~ TESTP|TLO(�AT|UN TEXTURAL CLASS: 1 - / ��|{���\�ALL [�/�[o/�(�ITY PROPOSED 1.500GALLON SEPTIC TANK / (LENGTH + WIDTH) (28iDES) (2' H|(�H) (074 (�PO/S F ) = GAL/DAY �--~�--~-u � (33 5' + 12 83') ( 2 ) ( Z ) ( 0.74 (SP[VS.F.) = 137.1 GAL/DAY O^ 4400' PROPOSED 8{)L|O SCHEDULE 4OPVC p|pE 48 Fill ` _- ����TT��A� (�/�PA/�/TY 1t�. Loamy Sand 4287. �� PROPOSED DISTRIBUTION BOX \ - (LENGTH x WIDTH) (074 GPD/SF ) = GAL/DAY A -- PR�)POSED5UOGALLON LEACHING CHAMBER -- (335' x1283') (074GPD/SF ) = 318] GAL/DAY 20'` 4233' CORNER OF STONE (6) 71,5' \ = �_ -- | / \ \ \ -_-- ^--- ' ULoamy Sand 49- TOTALS' 10 '`E, | ""'E \ BY / ~' ' D | DESCRIPTION . ) � =- ~— � �-�� — � -TOTAL 3 36^ 41 0O' �����»����� ����U�� �������8� UPGRADE ' ^ - -------- PROPOSED v~����-�� SEPTIC o�� SYSTEM�� n �~x�x ��x- »�nu�^�x���~ ' p) TOTAL LEA{�H|NC�AREA G15 1 SO FT ' �E�F p�E�±�/ \' ` ' _ � � ! TOTAL LEACHING CAPACITY 455� GAL /DAY ~ PREPARED FOR: ��������X��� ����������������� �/� Y������ ����� /���N�� ��\ � =,= �°°,=� ENTERPRISES " r��-^*`~~^~ ' ' L/(Y(�UT) | (1931STATEH|GHWA' LOCATEDAT DECK 138z2 ��Z\| K���UTA ����AFl '��T�� 28\ /`��y�T����\��f { �� ��J1 D����� | `�^_. " . `-. ~ , .���_, °.' ` ����� � . SCALE 1 INCH 20FT DATE. JHNU8hY 9 ZUlU 13Z 33.0I u m zn 40 on rseT No KUo�lmQ. Standing or Weeping Obaanxad ^ 14 OF PREPARED BY� RESERVED FOR B(]ARDOFHEALTH USE ��� ����������������� INC.�� u-"~��`.��-u-x ^^^���, ^.��� EXISTING ML 3-BEDROOM 807 ���� �������������� ���<�W "_^^^^-, CRANBERRY HIGHWAY ^°°, ^ . DWELLING ���%-F ��kU�����M� N�� [1���� CD )N PORT EAST "v��, ^u-^ ,^.^�., ^°.". ^^"-~^^^"� SITE PLAN �U �� � U ��1�� ���� [1�77 �~�K U U�^ ��U ��� U�� =v^/�^-^ ~^�w^/, , ~.~ ° " °�� " ��" ^° � ---- ---------------^" �oamo �n�a SCALE. ' � i � � Drawn By MCP Designed By MCP oheweuo, jLC | _ / . ' `