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HomeMy WebLinkAbout0368 PRINCE HINCKLEY ROAD - Health (3) 348 Prince Hinckley Centerville A = 171 175 d I I TOWN OF BARNSTABLE LOCATION 3 � TI�i I C e, 4//1 kf, e G SEWAGE # VILLAGE Ce i1 der di A—J.- ,er ASSESSOR'S MAP & LOT /7l i7.3 INSTALLER'S NAME&PHONE NO. J o,7 e5 SEPTIC TANK CAPACITY v LEACHING FACILITY: (type)\� (size) NO.OF BEDROOMS B eER-9R OWNER •C e o 7), to-•C.L L PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: s, Maximum Adjusted Groundwater Talb to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist I within 300 feet of leaching facility) Feet Furnished by 1 fj OFFICIAL,INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C J' SYSTEM INFORMATION(continued) Property Address:349 Prince Ilmckley Centerville Ma.02632 Owner:Leo Plscmedi Date of Inspectlon:10292005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch ofthe sewage disposal system including ties to nt lees[two Permanrm ref celandmarks or Benchnuks.Locate all wells wvhm 100 feet Locate where w u supply enters the building BACK OF HOUSE B TANK A-1=13' B-I=45' 1 O-BOX A-2=28'6' Foo S S SAS' � A-3=37' B-3=52' ❑2 S 3 73 L 0 4ti eN � � SEWAGE PERMIT NO. VtLLACE INSTALLER'S NAME a A DRESS G�� A. cm," c. T o . e U1 ODE R OR OWNER j DATE PERMIT ISSUED DAT E COMPLIANCE ISSUED ��/ �� P, Po rc l^ 4S 13 i� o2g~ 371 }ct 06 13 10:07p P.1 �e Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. Citylrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered In any way. Please see completeness checklist at the end of the form. Important:When A. General Information on t the compng out uter,forms ���`` �,���OF 44,q use only the tab ya .^V� keyto move your 1• Inspector: S. currsor-donoot p �9� v ���?� JAMES use the return James D.Sears a = Name of Inspector key. ;v, Capewide Enterprises,LLC � Company Name •G•� 153 Commercial St. -_ %,,,F��SN�s "������° Company Address 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. )am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 16.000).The system: asses ❑ Conditionally Passes ❑ Fails c�I ❑ Needs Further Evaluation by the Local Approving Authority CO V 10-5-13 mXso bt6r's Signature Date O N Thl tern inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP_ The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. i t5ina.3113 Tile 5 o Official Inspection F tm.S� as Sewage Di�asal System Page 9 of 17 Oct 06 13 10:07p p.2 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary:Check A,B,C,D or E l always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B System Conditional) Passes: 1 �t Y ❑ 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 exfiltrabon 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): !Sins•3113 Title 5 ORciat Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 .Oct 0613 10:07p p 3 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. CityJTown state Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alamns not operational. System will pass with Board of Health approval if pumpslalarms are repaired. B) System Conditionally Passes (cunt.): ❑ 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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ NO(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 ❑ NO (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ NO (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 15.3030)(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 Mina-3J13 Title 5 Of iidef hapection Form:Subsufteoe Sewage Disposal System•Page 3 of 17 Oct 06 13 10:08p p 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner owner's Name Information is Centerville MA 02632 10-5-13 required for every page. City/Town state Zip Code Date of Inspection B. Certification (cost.) 2. System will fail unless the Board of Health(anal 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 ❑ U Liquid depot in anspiiiiiil is less than 6"below invert or available volume is less than %day flow .C&4e#1a6: t5i,s.-313 Title 5 Official Inspection Form:Subsurface Sewage Disposal system-Page A of 17 Oct 06 13 10:08p p.5 Commonwealth of Massachusetts Title '5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. _ Property Address Joan Fleming y Owner Owners Name information is required for every Centerville MA 02632 10-5-13 page. City7Town 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- 10,000g pd. ❑ ® 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 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•3J13 Tft 5 Official tnspedion Form:Subsurface Sewage Disposal System•Page 5 or 17 Oct 06 13 10:08p p.6 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information required for every Centerville MA 02632 10-5-13 page. Citylrown 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 r this inspection? ecently or as part of ❑ Were as built plans of-the system obtained and examined?(If they were not available note as NIA) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ❑ Was the site inspected for signs of break out? 0 ❑ 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 sae 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-3M 3 TIM 5 Official Inspeetian Farm:Subsurface SeAw9e Oisposat System•Pega 6 of 17 Oct 06 13 10:09p p 7 Commonwealth of Massachusetts Title 5 Official Inspection Form a' -- - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name informatrun is required f every Centerville wired for eve MA 02632 10-5-13 page. Cityrrown state Zip Code Date of Inspection D. System Information Description: The system is a 1000 Gal. Tank D. Box and five infiltrators. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection information in this report.) ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage (gpd)): 2011-147,000Ga. Detail: 2012-180,000 Gars Sump pump? ❑ Yes JD No Last date of occupancy: Present Date Commerciadlndustrial 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: l5ins-V13 Tige 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 or 17 Oct 06 13 10:09p p,g Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 34B Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information red is Centerville MA 02632 10-5-13 required for every page. Cityfrown 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•3M 3 Title 5 Official Inspection Fame Subsurface Sewage Disposal System•Page 8 of 17 Oct 06 13 10:09p p.g Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Joan Name information is Centerville MA 02632 10-5-13 required for every 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: Tank NA-Leaching 2006 Permit # 2006-025 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 27 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.): Peeing is 4" PVC SCH 40. Septic Tank (locate on site plan): Depth below grade: 5 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal_ Precast Sludge depth: lip 15ins-3113 Title 5 Olrwal Inspection Form:Subsurface Sewage Disposal System-Pape 9 of 17 Oct 06 13 10:10p p.10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. c4rrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 1 Distance from top of scum to top of outlet tee or baffle 8" Distance from bottom of scum to bottom of outlet tee or baffle 17'. How were dimensions determined? Asbuilt- Plan-Tape Sludge Judge _ Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank and outlet cover at 15" below grade wlinlet cover at 8". In and outlet tees. No sign of leakage or over loading. Grease Trap(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑ fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date L5ins-3113 Title 5 Vidal Inspection Forth:Subsurface Sevrape Disposal System-Page 10 or 17 Oct 0613 10:10p p.11 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. City[rown 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: pate Comments (condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3/13 Tr1le 5 Of el Inspection Form:Subsurface Sewage Dispwl System•Page 11 d 17 Oct 06 13 10:10p p.12 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming C Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page. Cityfrown 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"x16"-20"below grade. Box is clean and solid w/one line out. No sign of over loading or solid cant'over. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ Now Alarms in working order: ❑ Yes ❑ No" Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Depose]System-Page 12 of 17 Oct 06 13 10:11 p p.13 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is Centerville required for every MA 02632 10-5-13 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 5 ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativetalternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is five infiltrators. Hi cars w/3 1/2'stone. Ck. D. Box and camera out to leaching, clean and wet. No sign of over loading.or solid carry over. 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 t57ns-3/13 Tille S Official inypar,7ion Form:Swb3urrace Sewage Maim""am-Page 13 of 17 Oct 06 13 10:11 p p.14 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is Centerville MA 02632 10-5-13 required for every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc_): Privy(locate on site plan): Materials of construction: Dimensions - Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): 15ins•3f13 TRIe 6 official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Oct 06 13 10:11 p p.15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owner's Name information is required for every Centerville MA 02632 10-5-13 page_ Citylrown State Zip Code Date of Inspection D. System Information (cunt.) 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 �17.13-�- LU ;, A R, 3 13-3 - t3.3� f 3 6 15ins-3/13 - Title 5 OlflBal Inspeditxt Form:Subsurface Sawago Dlspoeal System•Pegs 15 of 17 Oct 06 13 10:11 p p.16 Commonwealth of Massachusetts Title 5 Official Inspection Form i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 348 Prince Hinckley Rd. Property Address Joan Fleming Owner Owners Name information is required for every Centerville MA 02632 10-5-13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Nd . Estimated depth to igh ground water: 11' 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: 1-10-06 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: T.H.on design plan 11'no G.W.. Bottom of chambers at 3' below grade. Bottom of chambers at 8' above T.H. Depth. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ms-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Pape 16 of 17 _Oct 06 13 10:12p p.17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 348 Prince Hinckley Rd. _ Property Address Joan Fleming Owner Owner's Name information required for every Centerville MA 02632 10-5-13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed System Information—Estimated depth to high groundwater Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 f �O STABLE j Q� TOWO LOCATIOI' SEWAGE # VILLAGE �TH/l) t,`�- ASSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE No SEPTIC TANK CAPACITY 07b clW� LEACHING FACILITY: (type) NO.OF BEDROOMS _ BUILDER OR OWNER PERMTTDATE: �"? �* COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility-(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by Fou No.9W `P _0 a 5 Fee 10 } THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTHfDIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes Rpplication for Migozal *pztem Congtruction Permit Application for a Permit to Construct( ) Repair( ) Upgrade('<Abandon( ) ❑ Complete System dividual Components Location Address or Lot No.3 LJ f OQC e VY- t` Owner's Name,Address,and Tel.No. Assessor's Map/Parcel l G Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. -dd`�j (_7Cr Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) — gpd De7in flow provided ���'`7 gpd c. Plan Date 0 Number of sheets Revision Date 0 Title -e 01 Size of Septic Tank k 000 ��' Type of S.A.S. �Ac., Description of Soil CQ kW<I!f t SA71-�A, C yt4 • ! Nature of Repairs or Alterations(Answer when applicable) Al— 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 Bo Si ned Date Application Approved by Date Application Disapproved by: Date for the following reasons Permit No. i Date Issued No. t9d G —0 Fee Q� � . ' ' d 4 SETT`S Entered in computer: z T1H. COMMONWEALTH OF MASSA04u PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE MASSACHUSETTS Yes ZIppYication for Migogal *V.tem Con,5truction permit Application for a Permit to Construct O Repair O Upgrade( bandon O ❑Complete System 79111flividual Components Location Address or Lot No.3,y f,I`Ne if tv�c ��­ Owner's Name,Address,and Tel.No. Assessor's Map/Parcel , _ "� ! `j C -re ` 1 Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. Type of Building: Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder ( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) — gpd Desi n flow provided ���'c7� gpd X Plan Date Number of sheets Revision Date V � Title ^�J C, ,' t Size of Septic Tank ,k 000 c fir`' Type of S.A.S. `C c C'V:N-Vc-�G t2 Description of Soil tT_ co ( y<,!!� 1 Sor-,a— U tA v� _ Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement:; `5 r 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 iZn�ed Ule Date —� Application Approved by Date ? Application Disapproved by: Date for the following reasons Permit No. n�' 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 e A at f i NLe ►� �z►� tJi� has been constructed in accordance with the provisionsbTitle 5 and the for Disposal System struction Permit No. (D 7) — dated Vt, Installer 5 Designer +5 ' #bedrooms 75 Approved design flow 330 d gpd The issuance of this permit shlll noY/bbe construed as a guarantee that the system will no ' as designed. Date / 1 Inspec o r ———————————--------------------------------- No. r 7 Fee !y G THRE COMMON—WEALTH-OF MASSACHUSETTS. PUBLIC HEALTH DIVISION—BARNSTABLE, MASSACHUSETTS Mi5po,5a1 ,*pgtem ConEtruction permit Permission is hereby granted to Construct ( ) Repair ( ) Vpgrade ((,�Abandon ( ) System located at ?t(C> �f ut-'« v o-c and as described in 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: Constru tion must be completed within three years of the date E this pe Date Approved by d.. Town of Barnstable F THE Tp� o Regulatory Services Thomas F. Geiler, Director BARNSTABLE, 9�p MASS. Public Health Division 'F1 39. ' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Designer: Shay Environmental Services, Inc: Installer: Address: P.O. Box 627 Address: ,5 --(t&jTi)N c5°T: East Falmouth, MA 02536 G;i*�(CIMW_rw, MP�, On AM 616 5 i c Srq cS, was issued a permit to install a da ) (installer) septic system at '>49 based on a design drawn by (address) Shay Environmental Services, Inc. dated— Q1 2.8 1 m:., (designer) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. 00 OF qS moo`' CARMEN nstal er re) SHAY. No. 1161 0 'PFa/3TERA` SANITAR\PN signer's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:Health/Septic/Designer Certification Form 9/16/03 Notice: This Form Is To Be Used For the Repair Of Failed Septic Systems. Only PERCOLATION TEST AND SOIL EVALUATION EXEMPTION FORM I, �11-tjnr4 E, SAA q%? hereby certify that the engineered plan signed by me dated 2 3 0 concerning the property located at 344Bme e !�«ck\e,,` Q4ow��1c meets all of the following criteria: • This failed system is connected to a residential dwelling only. There.are.no commercial or business.uses.associated with the.dwelling. • The soil is classified as.CLASS I and the percolation rate is less than or equal to 5 minutes per inch. The applicant may use historical data to conclude this fact or.may conduct deep test holes and percolation tests.at the site without a health agent present. 0 There is no increase in flow and/or change in use proposed • There are no variances requested or needed. • The bottom of the proposed leaching facility will be located no less than five feet above the maximum adjusted groundwater table elevation. [Adjust the groundwater table using the. Frimptor method when applicable] Please complete the following: A) Top of Ground Surface Elevation(using GIS information) Jr B) G.W. Elevation 25 +adjustment for high G.W. 2 DIFFERENCE BETWEEN A and B Q SIGNED : DATE: Z O 3 NOTICE Based upon the above information;a repair permit will be issued for bedrooms maximum.. No additional bedrooms are authorized in the future without engineered septic system plans. Zs2 cze C. gASepric\percexemp.doc Town of Barnstable Regulatory Services DARNSTABLE Thomas F. Geiler,Director y MASS. Public Health Division ArFO MA'S A Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 January 12, 2006 Mr Leo Piscatelli 348 Prince Hinckley Centerville, MA 02632 NON-COMPLIANCE WITH STATE ENVIRONMENTAL CODE TITLE V. The septic system owned by you located at 348 Prince Hinckley, Centerville, MA,was inspected on, July 27th 2005. By Patrick T. Sullivan, a certified septic inspector for the State of Massachusetts. The inspection of your septic system showed that your system had"FAILED"under guidelines of 1995 STITLE 5 (310 CMR 15.00)DUE TO THE FOLLOWING: Septic system is in failure You have 2 years from the date of the system failure to bring the system into compliance. If there are any questions about this reminder, please feel free to contact the Barnstable Health Department. BARNSTABLE ALTH DEPARTMENT omas A. McKean, R.S., C.H.O. Agent of the Board of Health ' Commonwealth Of Massachusetts Executive Office Of Environmental Affairs Department Of Environmental Protection TITLE 5 Official Inspection Form -Not For Voluntary Assessments Subsurface Sewage Disposal System Form Part A Certification Property Address:348 Prince Hinckley Centerville Ma.02632 Owners Name:Leo Piscatelli Owners Address:348 Prince Hinckley Centerville Ma.026323�� Date of Inspection: 10/29/2005 Name of Inspector(please print)Sean M.Jones Company Name:S.M.Jones Title V Septic Inspectors Mailing Address: 74 Beldan Ln. Centerville Ma.02632 Telephone Number:508-7784597 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 hm a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes i'3 C. C Conditionally Passes t Needs further evaluation by the Local Appro Author;i j X Fails Inspectors Signature Date: 6 V The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer,if applicable,and the approving authority. Notes and Comments:At time of inspection, water level at leach pit was above bottom of inlet. '"This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Page 1 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(coNTINUED) Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 Inspection Summary:Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B.System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or Repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the_for the following statements.If"not determined"please Explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally Unsound,exhibits substantial infiltration or exfiltration or the tank failure is imminent.System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it structurally sound,not leaking and if a Certificate of Compliance Indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or Obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with Approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(S).The system will Pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 C.Further Evaluation is required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system Is failing to protect public health,safety or the environment. 1.System will pass unless Board of health determines in accordance with 31OCNM 15.303(1)(b)that the System functioning in a manner that protects the public health,safety and the environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a Surface water supplyor tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a Private water supply well**.Method used to determine distance **This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform Bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other Failure criteria are triggered.A copy of the analysis must be attached to this form. 3.Other: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(CONTINUED) Property Address:348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ _ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool _X_ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. X_ _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ _ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/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 _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X_ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X_ Any portion of cesspool or privy is within Zone 1 of a public well. _X_ Any portion of cesspool or privy is within 50 feet of a private water supply well. X_ Any portion of cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 pp,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form.] _X_ _ (Yes/No)The system fails.I have determined that one or more of the above criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large systems:N/A To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone 11 of a public water supply well If you answered"yes"to any question in section E the system is considered a significant threat,or answered "yes"in section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under section D shall upgrade the system in accordance with 310 CM15:304.The system owner should contact the appropriate regional office of the Department. OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address:348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health X_ Were any of system components pumped out in the previous two weeks? X _ Has the system received normal flows in the previous two week period? X_ _ Were as built plans of the system obtained and examined?(If they were not available note as N/A) X_ _ Was the facility or dwelling inspected for signs of sewage back up? X_ _ Was the site inspected for signs of break out? _X_ Were all system components,excluding SAS,located on site? _ _X_ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tee,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No X _ Existing information.For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance Is unacceptable)[310 CMR 15.302(3)(b)] OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 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):-3 3 0 Number of current residents: 2 Does residence have a garbage grinder(yes or no):—NO Is laundry on a separate sewage system(yes or no):_NO_[if yes separate report required] Laundry system inspected(yes or no):—N/A Seasonal use:(yes or no)NO_ Water meter readings,if available(last 2 years usage(gpd): Sump pump(yes or no): NO_ Last date of occupancy/use:_ CURRENT COMMERCIAL/INDUSTRIAL N/A Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings,if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping records Source of information: August 2005 owner Was system pumped as part of the inspection(yes or no):—No If yes,volume pumped: gallons--How was this quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _X Septic tank,distribution box,soil absorption system Single cesspool Overflow cesspool Privy Shared system(yes or no)(if yes,attach previous inspection records,if any) Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be Obtained from the system owner) Tight tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Were sewerage odors detected when arriving at the site(yes or no): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 BUILDING SEWER(locate on site plan) Depth below grade: 30"below TOF Materials of construction: cast iron_X_40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): Joints were in good condition no evidence of leakage. SEPTIC TANK: X (locate on site plan) Depth below grade:_2`_ Material of construction:_X_concrete metal fiberglasspolyethylene other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions: 1000 gallons Sludge depth: 0" Distance from top of sludge to bottom of outlet tee or baffle: 0" Scum thickness: 0" r Distance from top of scum to top of outlet tee or baffle:_0" Distance from bottom of scum to bottom of outlet tee or baffle: 0" How were dimensions determined: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): Septic tank was not opened,my first step with this inspection was to open cover of leach pit System failed due to water level above inlet invert.No further step were taken. GREASE TRAP:_N/A_(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglasspolyethylene other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity,liquid levels As related to outlet invert,evidence of leakage,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner: Leo Piscatelli Date of Inspection: 10/29/2005 TIGHT or HOLDING TANK: N/A_(tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: concrete metal fiberglasspolyethylene other(explain) Dimensions: Capacity: gallons Design flow: gallons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX:_X (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: 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 was not opened,see septic Tank comments. PUMP CHAMBER: N/A_(locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address:348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 SOIL ABSORPTION SYSTEM(SAS):_X_(locate on site plan,excavation not required) If SAS not located explain why: Type _X_Leaching pits.Number:_1_ Leaching chambers,number: Leaching galleries,number: Leaching trenches,number,length: leaching fields,number,dimensions: overflow cesspool,number: innovative/alternitave system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): Water level at time of inspection was above inlet invert. CESSPOOLS: N/A_(cesspools must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): PRIVY: N/A_(locate on site plan) Materials of construction: Dimensions Depth of solids Comments(note condition of soil,signs of hydraulic failure,level of ponding,condition of vegetation,etc.): .OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner: Leo Piscatelli Date of Inspection: 10/29/2005 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water_5_feet+++ Please indicate(check)methods used to determine the high ground water elevation: _X_ Obtained from system design plans on record-If checked,date of design plan reviewed: 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: OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) 1 Property Address: 348 Prince Hinckley Centerville Ma.02632 Owner:Leo Piscatelli Date of Inspection: 10/29/2005 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent referencelandmarks or Benchmarks.Locate all wells within 100 feet.Locate where water supply enters the building BACK OF HOUSE U- L- A TANK A-1=13' B-1=45' 0 1 D-BOX A-2=28'6" 0 B-2=55' S.A.S. A-3=37' B-3=52' ❑ 2 3 *NOTE: ALL PIPES ARE TO BE 4" SCHEDULE 40 P.V.C. 0AkgDNF!*= / i SECTION A -A ;. '�. ! ? 10'min. from + sulioN ry 1% ,� I Existing Foundation [house to septic tank D-eoX r must be PROFILE VIEW OF ADDITION TO LEACHING SYSTEM SET LEVEL FOR AT LEAST 2 FT. 12" CONCRETE COVER TOP OF FOUNDATION = ELEV. 100.00 (Assumed) Septic tank coven must be wn 6 in. of finished grade ;� �'°t ? / t% j r•! a within 6 in. of finished grade , .- Grade over Septic Tank-99.00 Grade over D-Box- 9&50 over SAS- 9ds0 3" of 1/8" - 1/2" Washed Peaston5 KNOCKOUTS •�'�� =s 2 • J r 3/4" to 1 1/2 Washed Crushed Stone \: s ` S.S' 1 l 12" INLET J�/ / �•'A,.. iX�o 4'/ `� rC./+t i a i S 0.02 OUILET 3 HOLE N-10 4"PVC(CAPPED)INSPECTION PORT TO BE + ST. BOX 3' Maximum Cover INSTALLED AND TO BE WITHIN 6"OF GRADE �' {� O 12' EXIST. S-0.01 or Greater -;`- •t , r t� JC Top OF System- Elev. -95.75 �, p'" 74!nine•Ni.elde)Ad EXIST.PIPE O N 1,000 GAL // r` t` O 35' Per foot 0"Etfective Depth FROA EXIST. FDl1NDATIQJ rn SEPTIC TANK 0.01 1S 5" 4" - SCH. 40 T r o s PLAN SECTION CROSS-SECTION > n H-1000NCRETE rri FIa L 0.83' (10 inches) 3 5 Units E 6.25' = 30' 3'N O SYSTEM PROFILE 6 in.of 3/4--1 1/2" m o � rrOi 31.25 3 HOLE H-10 DISTRIBUTION BOX L' ,�• P8 lu `; SlonrvCl� R'r ! ,' compacted stone I c o u ' A rn 37.25' NOT TO SCALEn 1 M f Not to Scale - - o > 5 3.5' I� 4- 63.5' Effective Length o f` cn 10' o S❑IL ABSORPTION SYSTEM (SAS) GENERAL NOTES irr.of 3/4"-1 1/2' 0 compacted stone 00 Effective WidthINFILTATR❑R HIGH CAPACITY (H-20 LOADING)/ GE❑RGE ❑'BRIEN NOTE ALL COMPONENTS MUST HAVE RISERS TO WITHIN 6" BELOW GRADE 0 1. Contractor is responsible for Digsafe notification, Verification of Utilities 0 m (OR EQUIVALENT) Not to Scale and protection of all underground utilities and pipes. i? Bottom of Test Hole 1 Elev=87.00 NOTE OVERALL HEIGHT OF INFILTRATOR IS 18" FFECTIVE HEIGHT IS 10" 2. The septic tank and distribution box shall be set Groundwater Observed - NONE OBSERVED � level on 6" of 3/4"-1 1/2" stone. 3. Backfill should be clean sand or gravel with no stones over 3" in size. 4. This system is subject to inspection during installation PERCOLATION TEST by Carmen E. Shay - Environmental Services, Inc. 5. The contractor shall install this system in accordance Date of Percolation Test: JANUARY 10, 2006 with Title V of the Massachusetts state code, the approved plan Test Performed By. CARMEN E. SHAY, R.S., C.S.E. and Local Regulations. Results Witnessed By. WAIVER (Per Barnstable B.O.H.) 6. If, during installation the contractor encounters any EXCAVATOR: Shay Env. Svcs. soil conditions or site conditions that are different Percolation Rate: Less Than 2 MPI 0 36" from those shown on the soil log or in our design installation must halt & immediate notification be Test Hole Test Hole made to Carmen E. Shay - Environmental Services, Inc. No. 1 No. 2 cG 7. No vehicle or heavy machinery shall drive over the DEPTH SOILS ELEV. DEPTH SOILS ELEV. Calseptic system unless noted as H-20 septic components. 0 98. 00 0 98.50 8. Install Tuf-T'ite gas baffles or equals on all outlet tee ends. Sandy Loam Sandy Loam I 9. All Distribution Lines shall be 4" diameter Schedule 40 NSF PVC pipes. 10 rR 3/2 10 YR 3/2 100.¢0' 10. All solid piping, tees & fittings shall be 4" diameter 0"-9" Ae 98.25 0'-6" A Schedule 40 NSF PVC pipes with water tight joints. Y Sandy Sand e 98.00 11. Municipal Water is Connected to ALL OF The Residence and Abutting Loam Loam Properties Within 150 Feet. 10 rR 5/6 � t0 rR s/e 3 ' THE PROPERTY LINES ARE APPROXIMATE AND 9"- W. Be 95.00 6"- 36" B. 95.50 i COMPILED FROM THE SURVEY PLAN GENERATED BY Medium/Coarse Medium/Coarse TEST HOLE BARTER & NYE OF OSTERVILLE, MA Sand sand j ELEV.= 98.00 ENTITLED "CERTIFIED PLOT PLAN OF LOT #298 PRINCE HINCKLET ROAD, z r 7/4 25 r 7/4 CENTERVILLE, MA DATED SEPTEMBER 12, 1984 36"- 132 C, 36"- 132 C, .87.5027.5' 37•2�' 35.25' AND IS NOT INTENDED TO BE A SURVEY PLOT PLAN ,•,M. Ar I IT SHOULD BE USED FOR NO PURPOSE OTHER THAN D-Box THE SEPTIC SYSTEM INSTALLATION. ,•., It.rTr .. .;-..: ,�� 1 i • • ,, EXISTING LEACH PITTO BE PUMPED OUT AND FILLED IN PLACE.. j - p •i `.�sr-t. y I \ NOTE: ANY STRIPPED OUT SOIL CONTAINING LEACHATE TEST HOLE #2 �� Failed FROM THE 'EXISTING LEACH PVT TO BE DISPOSED ----------- j ELEV.= 98.50 _ �` - _ _ CH PIT �1• OF AS PER BOARD OF HEALTH SPECIFICATIONS. THERE ARE NO WETLANDS ARE PRESENT WITHIN 200' OF THE PROPERTY Perc #1 ` Depth to Perc: 40" to 58" 99--_ _ Perc Rate= 2 MPI 4 -___98 ASSESSORS MAP 171 PARCEL 173 Groundwater Not Observed No Observed ESHWT LOT #297 LOT #299 LEGEND ADJUSTED H2O Elev. = None EXIST. 1000 GAL DENOTES PROPOSED ""10 1 SEPTIC TANK 104X 1 2-18" DIAM. ACCESS MANHOLES _ ---------------------- SPOT GRADE e PAT70 DENOTES EXISTING T •.;_...•. .•:.<_:--�• :_::.=.,:;-•:�---• c � PROJECT BENCH MARK x 104.46 SPOT GRADE \ TOP OF FOUNDATION .f• �= co L i ELEV. = 100.00 (Assumed) PL xISTING EXISTING PROPERTY LINE INLET / - `_ .` ou GARAGE rLv _/ 3 BEDRooar 91 P PROPOSED CONTOUR k:= THE ACCESS COVERS FOR THE_ HOUSE / DISTRIBUTIONND BOX A LEACHING COMPONENT // - - - -- SET DEEPER THAN 6 INCHES BELOW FINISHED #348 -9 7 EXISTING CONTOUR GRADE SHALL BE RAISED TO WITHIN 6" OF ` STEEL REINFORCED PRECAST CONCRETE FINISHED GRADE PLAN VIEW nvsnu.L TUF-TITS GAS BAFFLES OR EQUALS DEEP TEST HOLE &��� F PERCOLATION TEST LOCATION 3-24" REMOVABLE COVERS 71 I ' _K_____------------- 6 FOOT STOCKADE FENCE 3' ¢nin,clearance .g8 SET B"mInT- 2• min. Inlet to outlet fr in. -_ tY � ��� I LOT #298 - OUTLET - to• � ''�"� Ie1°r-,r j EXIST. j S 16,025 Square Feet +-f, LOT 5' -7• ,' I DRIVEWAY I ,,-' P I P �AI VI I4'-0" min. 99 � �' w Lib depth OF PROPOSED SEPTIC SYSTEM UPGRADE i ' --- I--- ` 100.00 4' _ MR. LEO PISCATELLI CROSS SECTION END-SECTpr ION PREPARED FOR -- � AT TYPICAL 1000 GALLON SEPTIC TANK ------------98--- ' �'� �_--__-----_ --------------- #348 PRINCE H I N C K LEY ROAD NOT TO SCALE CENTERVILLE, MA Design Calculations PRINCE HINCKLE Y R OA D OOFlq', PREPARED BY: Number of Bedrooms: 3 Equivalent to 330 Gal./Day (330 Gal./Day Min. per Title V) (40 FOOT RIGHT OF 'WAY) �C' /y�Garbage Grinder: No (� RNEW E SffA Y Leaching Capacity Proposed: 330 Gal./Doy Minimum (Min. Per Title V) Septic Tank - 2 x 330 Gal./Day = 660 USE EXIST. 1.000 GAL Septic Tank. S ENVIRONMENTAL SERVICES, INC. 0 c. SOIL ABSORPTION AREA: Using percolation rate of <2 min./inch 11$1 Bottom Area: 0.74 gal/sq. ft. x 372.5 sq. ft. = 275.65 gallons P.O. BOX 627 Sidewall Area: 0.74 gal./sq. ft. x 78.72 sq. ft. = 58.25 gallons 0 20 40 50 Providing: = 333.90 gallons G►STEPL�O EAST FALMOUTH, MA 02536 SgN►TARtPa TEL/FAX 508-539-7966 Use: (5) INFILTRATOR HIGH CAPACITY H-20 UNITS, HAVING A 0.83' (10 INCHES) EFFECTIVE DEPTH, SCALE: 1"=20' DRAWN BY: CES DATE: JANUARY 23, 2006 TO BE USED WITH 3.5' OF WASHED STONE ON THE SIDES, AND 3.5' OF WASHED STONE ON THE ENDS. NO STONE UNDER. SCALE: 1"=20' PROJECT#SD855 FILENAME: SD855PP.DWG SHEET 1 OF 1