The URL can be used to link to this page

Home My WebLink About1071 SHOOTFLYING HILL RD - Health 1071 SHOOT FLYING HILL RD, CENTER A= 1 .1-026 No. 42101/3 ORA aim cdl qowz ESSELTE 10% (* ® O O O i i i Town of Barnstable Department of Regulatory Services t Public Health Division Date �bp `a+�39. ,�� 200 Main Street,Hyannis MA 02601 r rfa�* , Date Sche Fri duled Time Fee Pd . ' �d—� . � t� I L.4y) Soil Suitability Assessment for Sewage Disposal' Performed'By: 1`ef pie(�Jt4—ei� �'l�i—l "Z Witnessed By; pit TarH� �� LOCATION& GENERAL INFORMATION O- Location Address ` 7 ( s V�41'45 1 p tt I l cc✓�Owner's Name A)_ le ZJ,�f'P. \, Q f`L Address I z2j MQ< M A vtut i s Nlb4 Q 26 \ Assessor's Map/Parcel: 19 1—0 Engineer's Name NEW CONSTRUCTION REPAIR tla�� / Telephone'#. SQ Land Use /C C S;6 °en�-c �l r Slopes Surface Stones lu Al'_4 Distances from: Open Water Body;1/ .3 cr Q ft 'Possible Wet Area Nd r� ft Drinking Water �[�j) ft Drainage Way N!fV_ ft Property Line `-ft Other ft .SKETCH:(Street name,dimensions of lot,exact locations of test,holes&>pere tests,locate wetlands in proximity to holes) (ct .. . I,� p Parent material.(geologic) f o�Cts Depth to.Bedrock. d A< Depth to Groundwater. Standing Water in Hole: d/tX Weeping from pit fence Nd!� Estimated Seasonal High.Groundwater DETERMINATION FOR SEASONAL HIGH.WATER TABLE Method Used: Depth Observed standing in obs.bole: in. Depth to soil mottles: - — in. Depth to weeping from side ofobs.hole:' in, Groundwater Adjustment tY. Index Well# Reading Date: Index Well level Ali,factor,,,,,,,,,.,,_ Adj.Groundwater Level PERCOLATION'TEST Bate , Thne Observation Hole# Time at V Depth of Perc 1 U Time at V Start Pre-soak Time 2 t Time(0"-6") End Pre-soak y Rate Min:/Inch. L Z Site Suitability Assessment: Site`Passed Site Failed: Additional Testing Needed(Y/N) Origina.t: Public Health Division Observation Iiole Data To Be Completed on Back----------- ***If percolation test is to.be conducted within 100' of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. Q:ISEPT►0PERCFORM[.DOC ` I DEEP OBSERVATION HOLE LOG Hole#, 1 Depth from Soil Horizon Soil Texture soil Color Soil Other Surface(in.) (USDA) (Iylunsetq Mottling, (Structure,"Stones;Boulders.. C-onsigency. ravel 0 —16 Lz-� Sq4 Wyfz ilz I q -30 7�7 q"j L0-rq-7/(. �Q _gyp C-i Caa c;e 5--, . Z-5-177 '/ 7 t e ra b &6 -13 DEEP OBSERVATION HOLE LOG Hole# 2 Depth from Soil Horizon Soil Texture Soil Color. Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones Boulders. Consistency,% ravel f Z -Zj fod Lt 4/ 7 iU -(37- C� (�l-C Sam �.,s'7 ` �- 1074 0) DEEP OBSERVATION HOLE LOG Hole# Depth.from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. n iste c Grave DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Textutc Soil Color, Sell Other Surface(in) (USDA). (Munseil) Mottling (Structure,Stones,Boulders. Consi ten �e Flood Insurance Rate Map: Above 500 year flood boundary No_ Yes _ Within 500 year boundary No X, Yes Within 100 year flood boundary No Yes Depth of Naturally Occurrine Pervious Material Does-at least four feet of naturally occurring pervious matey i'exist it all areas observed throughout the area proposed for the soil absorption system? J:. � — If not,what is the depth of naturally occurring pervious maCeria17 Certification ,� I certify that on t< �(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 trainin xpertise,and experience described in lQ CMR 15.017. o Signature . Date Q:\.S•EP1rl0,PERCFORM.DOC TOWN OF BARNSTABLE LOCATION 10 7/ �e, 1Q SEWAGE# VILLAGE c�'' f Pl✓r%.fie ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY `L / f—oo LEACHING FACILITY:(type) �'r4 61.,14-4) s (size) 33 xr?'PC 3� NO.OF BEDROOMS V OWNER k L d 9- PERMIT DATE: 21 s t COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY /y��G�F�'T �!►�.7 e. a is 1300, �. C+ Z 33 � c p- 23ZZ /i No. � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftpliLation for )Disposal *pstiem Construction i3Prmit Application for a Permit to Construct( ) Repair X) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /b Owner's Name,Address,and Tel.No. �_ —T Alf � Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Y CV ! 'rf 9 Designer's Name,Address,and Tel.No. .614-0 �✓r'ts a.,� Or-AM �q 14 ea// IA✓vf f/s ,,Lyre Type of Building: �jDwelling 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 Design flow provided gpd Plan Date Number of sheets Revision Date s Title Size of Septic Tank sip Type of S.A.S. ��0 t9'4//�✓t ��1a�'✓�4/S Description of Soil Nature {o/.f.Repairs or Alterations(Answer when applicable) )l� 6-4/flGff +, Cal c,✓�1�i ll� to Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. �j' Sl !ram Dater 2 l-�� Application Approved by Date % Application Disapproved by Date for the following reasons Permit No. l�,2 Date Issued • No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes . PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 4pliLation for ;Disposal 6pstrin Construction Permit Application for a Permit to Construct( ) Repair ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. /b 6¢ I Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. 1)rpe of Building: Dwelling No.of Bedrooms r Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) /yQ gpd Design flow provided gpd . Plan Date Number of sheets Revision Date Title V ,r Size of Septic Tank Z<-06 Type of S.A.S. 3 �a0 6-414.r Z:2 W_. Description of Soil " t. Nature of Repairs or Alterations(Answer when applicable) �p �� ya 1*0 Date last inspected: , Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Si —� Date ^ Application Approved by Date Application Disapproved by Date for the following reasons � - Permit No.&I—q Date Issued --------------------------------------------------------------------------------------------------------------------------------------- (� THE COMMONWEALTH OF MASSACHUSETTS 1,BARNSTABLE,MASSACHUSETTS �r� I (tEr. If tatP of �tCDttYtJllattLP oAR,( y�l( �� 13Y �-) /r THIS IS TO CER IFY,that the On-site Sew ge' spo �yt/m�onstructed( ) Repaired( ✓� Upgraded( ) i vt Abandoned( )by -- :1 f�l._c9 r 1) �2W-Cr at�0 �� ej� /-/7� c /��/� �p has been constructed in accordance with the provisions of Title 5 and the for isposal System Construction Permit Ne 19 —��2 i;44 dated ,51Z.1� 2b1 � � Installer �� i�AJ nQ Designer , #bedrooms �Z Approved design flow �/d gpd The issuance of this permi shall not be construed as a guarantee that the system will crio as esigned. % Date / Inspector C , 7 {� 4� No.2n.Q9 Feely l// THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS ]Disposal 6pstem Construction Permit Permission is hereby granted to Construct( ) Repair(k Upgrade( ) Abandon( ) System located at SA"I h y'/n w J " and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permi. Date �'1 1 Q Approved by Town of Barnstable OF THE t 0, Regulatory Services Richard V. Scali, Interin> Director unwaSTast.s,STABLE).. 9q, 6 9- `0� Public health Division ArFDAAP�p Thomas McKean,Director 200 Alain Street,Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-b304 Installer&DesignerCertification Dorm Date: S1jm(� Sewage Permit# �1_"f(��ssessor's Map\Pareel �� ( — OZ4 Designer: Li;�]l5 Y2 e-e-,.-- 4,Xjcr fj sJ�lr; Installer: P L13 0 e,v��seu�-ems__ �rcno� Address: j Z l Cr � .�iC/ P,,4 Address: �_� �- v� - L v1 On date d a permit to install a. (Installer) septic systeill at. l 7 l -Sheer}- , K it Z�_.._based on a design drawn by (address) (designer) - - I certify tbat 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. 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 R.egulatioils. 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 constructed ii :vith the terms of the ["A approval letters (if applicable) McENT�� -- (Installer's Signature) \ ` CNIL t40.35109 O .ge„�ft3iS'(E� � (Designer's Signature) (Affix Designe ere) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH. DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC IIEAL'I'I-1 DIVISION THANK YOU. Q:`.Setaic^,tiesi�ner Certification Form Rev 8-1.4-1 3.doc Engineers note:This certification is limited to an as-built inspection of system components as installed prior to backfitl.The engineer did not supervise construction of the system. The installer assumes responsioi!'ay or all.materials,workmanship,backGlling to specified grades with proper compaction and setting risers covers as shown on the design plan. VE Town of Barnstable Barnstable Inspectional Services Fmcac j W BARN6TABLE, `" � r639. Public Health Division p �e 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7008 3230 0002 5177 8001 December 28, 2018 CAMPBELL, MATTHEW W & JENNIFER E 1071 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1071 Shootflying Hill Road (Rear System), Centerville, MA, was inspected on 11/17/2018 by Sean M. Jones, 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: • Cesspool is lacking structural integrity. You are ordered to repair or replace the septic system within two (2) years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH s c ean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\I071 Shootflying Hill Road(Rear House System)Centerville.doc I Town of Barnstable • saxnrsrnsU. 6 h Regulatory Services Department lfD MA'l Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1) YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well. ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2) YEAR DEADLINE CRITERIA ❑ Single C.esspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe, relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER f Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts 19/- 0A(1P Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments rti 1071 Shootflying Hill Road (rear system) !�b, Property Address „ Matthew&Jennifer Campbell F Owner Owner's Name r. information is Centerville ✓ Ma 02632 11/17/2018 required for every t r,. page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information s�•f f- �a5� on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane ,Q Company Address Centerville Ma 02632 City/Town State Zip Code »� 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 11/17/2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 r Commonwealth.of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) . System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts ra 1Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owners Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 16.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool El ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 1/day flow ❑ ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ 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)] t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 r . Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): Number of bedrooms (actual): DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): Description: 0 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknown Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a 4 Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5in .doc•rev.7/26/2018 sp Title 5 Official Inspection Form:Subsurface Sewage Disposal System Page 8 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) V Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known)and source of information: septic tank and distribution box installed 1996, overflow cesspool unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 3.5 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.): Joints ok, no leaks or blockages. Vented through roof t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 18 i Commonwealth of Massachusetts p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .,, 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is Centerville Ma 02632 11/17/2018 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 3 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 gallons 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 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.): 1500 gallon septic tank was in good condition, water level was even with outlet invert. t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts �9 1 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owners Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): 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.): Distribution box was not inspected t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ia Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Septic tank and d-box added to existing block cesspool in 1996. Overflow cesspool was originally a single cesspool which served garage apartment. Cesspool was dry but has blocks that are starting to fall in resulting in a failing inspection due to structural integrity. 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 0 --.� 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments r 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 1 p i7 ,2 A ! `f 81 3Z A2 P 1�2 21 A3 �S g3 2© t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 • cam, Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments v 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 18 • Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (rear system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist)completed ® D. System Information: For 8: Tight/Holding Tank— Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 Town of Barnstable Barnstable Inspectional Services All-AMMiCaC j HAINbTASLY, M" . Public Health Division Argo s 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 t CERTIFIED MAIL#7008 3230 0002 5177 7998 December 28, 2018 CAMPBELL, MATTHEW W& JENNIFER E 1071 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1071 Shootflying Hill Road (Main House), Centerville, MA, was inspected on 11/17/2018 by Sean M. Jones, 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: • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1) year 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 c a��, HO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1071 Shootflying Hill Road(Main House System)Centerville.doc Town of Barnstable • sauvsrnsiE, 9� "5 � Regulatory Services Department prfD MA't� Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6, 2007 Rev. 5/11/16 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44 and Title V: 310 CMR 15.000) An"x"marked in the ❑is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑ Discharge or ponding of effluent to the surface of the ground o Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA tatic liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy below high groundwater elevation ❑ Any portion of the cesspool within a Zone 1 to a public well ❑ Any portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑ Any"conditionally passed systems" (broken cover, relocation of a pipe,relocation of a driveway due to H-10 components, etc) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER CIO- Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Commonwealth of Massachusetts Title 5 Official Inspection Form : Subsurface Sewage Disposal System Form - Not for Voluntary Assessments r'� 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville ✓ Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection �.J i Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. Inspector Information ?C tilling out forms rs�•{t /3�1 8 on the computer, use only the tab Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name key. 74 Beldan Lane Company Address Centerville Ma 02632 Cityrrown State Zip Code 508-658-3456, 774-248-4850 SI 4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 16.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. After conducting this inspection I have determined that the system: 1. ❑ Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ® Fails 11/17/2018 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owners Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑_ ND (Explain below): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of.Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: Lt&n.p.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �o Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootfl in Hill Road main houses stem Y 9 ( system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® 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 t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/2 day flow Required pumping more than 4 times in the last year NOT due to clogged or El ® 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 water supply 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 2000 gpd- 10,000 gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form < Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes" to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes" or"no"for each of the following for all inspections: Yes No ® ❑ 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)] t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts ro Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information 1. 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 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ❑ No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: 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 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: current Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form <o) Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. 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 Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 . page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2 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.): t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 1 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 gallons 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 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.): H-10 septic tank is located in paved driveway. Concrete inlet cover is to grade, outlet cover is paved over and not accessible. Tank was found full to top into riser. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form l; Subsurface Sewage M1jo, a age Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 7. 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 Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert unknown 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 r Commonwealth of Massachusetts Title 5 Official Inspection Form <ie Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City(rown State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: No records are available for this system. The system is assumed to be in failure due to the condition of the septic tank. Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp,doe•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owners Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): 12. 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 Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 13. 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.): t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ❑ drawing attached separately 2 Yww v t5insp.doc•rev.7/26/2018 d Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site (abutting property/observation hole within 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: Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form M1io Subsurface Sewage Disposal System Form - Not for Voluntary Assessments . 1071 Shootflying Hill Road (main house system) Property Address Matthew&Jennifer Campbell Owner Owner's Name information is required for every Centerville Ma 02632 11/17/2018 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed ❑ D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 �d CP . T711 a J f,, u.. ( jai i I Fi te t L -OZ� TOWN OF BARNSTABLE c1, T LI CATION 1011 S60+ A% Ri kk go-AD SEWAGE # '1 S- Pg S vII.LAGE ASSESSOR'S MAP & LOTZ21,694( INSTALLER'S NAME&PHONE NO. (J E Rc�t-SSOl4 5ePA1,L 775127C. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) G i L n t (size) NO.OF BEDROOMS I BUILDER OR OWNER PERMITDATE: 1 11-7 1 Z6S _COMPLIANCE DATE: 3 0 J F, 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 irs Ito �0'� to 430P 029� kSSESSORSMAPNQ .. No. /S� l V.�I PARCEL _ 'Fee 30 . 00 THE COMMONWEALTH OF MASSACHU PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS Application for ;Di!9pOga1 *pgtem ConotruCtion 3permit Application is hereby made for a Permit to Construct( )or Repair(x )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 1071 Shoot Flying Hill Rd Pat Cambell Centerville apartment Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. W.E. Robinson Septic P.O. Box 1089 Centerville Type of Building: Dwelling No.of Bedrooms 1 Garbage Grinder(nq Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Description of Soil gravel Nature of Repairs or Alterations(Answer when applicable) install a 1 , 500 gal tank « d-bo x to existing leach it (apartment) 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 Certifi- cate of Compliance has been issued by this Bo of H lth.., Signed Date 2 v Application Approved by Application Disapproved for the ollowi reasons Permit No. L Date Issued — 7 ——————————————————————————— _ __ ———— s� � ^+..'�.._.�,.+'c.:..�....-..._T''_-•r•.'�'—'y,r^`'~•'ate• ..- • ,.-v-. ^..r .+r ....-s y. .r�, y^. ..•'.� ....� .yr... �a+'��• ....w .. . �.� . .._ 30.00 �4 No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MASSACHUSETTS "RZfpplication for big ool *pgtem Construction Permit Application is hereby made for a Permit to Construct( )or Repair(X )an On-site Sewage Disposal System at: Location Address or Lot No. Owner's Name,Address and Tel.No. 1071 Shoot Flying Hill Rd ' v Pat Cambell Centerville a artment •, Installer's Name,Address,and Tel.No. Designer's Name,Address and Tel.No. rr� W.E. Robinson Septic p� i P„O. BoXr 1089 Centerville Type of Building: • Dwelling No. of Bedrooms 1 Garbage Grinder(nq Other Type of Building No. of Persons Showers( ) Cafeteria( ) `Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title A Description of Soil gravel Nature of Repairs or Alterations(Answer when applicable) install a 1 ,500 gal tank & d—box i ' to existing leachpit (apartment) - Date last inspected: „"'�'S. �� yn"•s J'Xµ�w,l_Y, -r.. �P' -o ..,s:'.s mot_ •"rs r Agreement: '• _ ...r+ -,, The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system F in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance has been issued by this Boa Id of H th.., Signed Date 9 Application Approved by 1 Application Disapproved for the o lowin reasons { Permit No._ — g g Date Issued 7 ======— ---------------------------- THE ____COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Certificate of Compliance - THIS IS TO CERTIFY,that the On-site Sewage Disposal System installed( )or reppaired/replaced( X)on byW.E. Robinson Septic for Pat Cambell a�GTr Shoo F y ng Hi 1 Rd apartment) has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. dated la - 7 -2 S. Use of this system is conditioned on compliance with the provisions set forth below: jV (� 30.00 No. C� Fee y THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Digpoga[ *pgtem Construction Permit Permission is hereby granted to W.E. Robinson Septic to construct( )repair(X )an On-site Sewage System located at 1071 Shoot Flying Hill Rd Centerville lApartment) 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. All construction must be completed within two years of the date below. S Date: �c� — �' Approved by CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT(WITHOUT DESIGNED PLANS) I, 1 hereby certify that the application for disposal works .construction permit signed by me dated Z2 — of , concerning the property located at /U J66�f'/ �'� hlj�� 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:e� L DATE: u LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER I Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted]. 1 . 1 f ! v' r i J . _ l� D0l-.:81 f,sG2 I2-CII-200CI 11•18 BR31STMILE. LN111 C:C IURT REIN c 1 R''( Cape Cod Bank and Trust Company,N.A. 307 Main Street Hyannis,MA 02601, -----—-------------------------—----------------—---ISpace Above This Line For Recording Dalai--------------------—----------—---------------- NlORT'GAGF, TI IIS MORTGAGE is made this December I ,2000,between the Mortgagor Patricia E. Ilogan-Campbelt('herein"Mortgagor")and the Mortgagee, Cape Cod Bank and Trust Company,N.A.,a National Banking Association,organized and existing under the laws of United States of America,whose address is 307 Main Street,Ilyannis,Massachusetts 02601,("herein Mortgagee"). WHEREAS, Mortgagor and Mortgagee have entered into a Home Equity Line of Credit Agreement (hereinafter referred to as the "Agreement") pursuant to which Mortgagee has agreed from time to time to make loans to Mortgagor under an arrangement whereby Mortgagor may borrow,repay and borrow again during the term of the Agreement. TO SECURE to Mortgagee the prompt and full performance of all obligations of Mortgagor under the Agreement, including without limitation the repayment of all indebtedness,with interest thereon;the payments of all other sums,with interest thereon,advanced in accordance herewith to protect the security of this Mortgage;and the performance of the covenants and agreements of Mortgagor herein contained,Mortgagor does hereby mortgage, grant and convey to Mortgagee,with power of sale,the following described property in the County of Barnstable,Commonwealth of Massachusetts, with MORTGAGE:COVENANTS: The credit line is in the amount of TWENTY THOUSAND AND 00l100 Dollars(U.S. 520,000.00)as set forth in the home Equity Line of Credit agreement and promissory note of even date. The land,together with the buildings thereon,situated in Barnstable,Barnstable County,Massachusetts,described as follows: Being LOT 17A as shown on Land Court Subdivision Ilan 24654-A(Sheet 2). The above described premises are conveyed subject to and together with the benefit of all rights,rights of way,easements,restrictions,reservations, statements,conditions and agreements of record,if any there be,insofar as the same are in force and applicable. For Mortgagor's title,see Certificate of Title No.78472. **formerly known as Patricia E.Hogan, which has the address of 1071 Shoot Flying Hill Road, Centerville, [Street][City] Massachusetts,02632 ("herein Property Address"); [Zip Code] . TOGETHER WITH all the improvements now or hereafter erected on the property,and all casements,rights,appurtenances,and rents,all of which shall be deemed to be and remain a part of the property covered by this mortgage,and all of tie foregoing,together with said property(or the leasehold estate of if this mortgage is on a leasehold)are hereinafter referred to as the"property". Mortgagor covenants that Mortgagor is lawfully seized of the estate hereby conveyed and has the right to mortgage,grant and convey the Property,and that the Property is unencumbered,except for encumbrances of record approved by Mortgagee.Mortgagor covenants that Mortgagor warrants and will defend generally the title to the Property against all claims and demands,subject to any encumbrances of record approved by Mortgagee. UNIFORM CONVENANTS. Mortgagor and Mortgagee covenant and agree as follows: 1. Payment of Principal and Interest. Mortgagor shall promptly pay when due the principal and interest(finance charge)indebtedness rated pursuant to the Agreement 2. Funds for Taxes and Insurance. Upon Mortgagee's request and subject to applicable law,Mortgagor shall pay to Mortgagee on the day monthly payments of principal and interest are payable under the Agreement,a sum (herein"Funds")equal to one twelfth of the yearly taxes and assessments(including condominium and planned unit development assessments,if any)which may attain priority over this Mortgage and ground rents on the Property;if any,plus one-twelfth of yearly premium installments for hazard insurance,plus one-twelfth of yearly premium installments for mortgage insurance,if any,all as reasonably estimated initially and from time to time by Mortgagee on the basis of assessments and bills and reasonable estimates thereof.Mortgagor shall not be obligated to make such payments of Funds to Mortgagee to the extent that Mortgagor makes such payments to the holder of a prior mortgage or deed of trust i f such holder is an institutional lender. CCB&T 4362 5/89 J � REQUEST FOR NOTICE OF DEFAULT AND FORECLOSURE UNDER SUPERIOR MORTGAGES OR DEEDS OF TRUST Mortgagor and Mortgagee request the holder or any mortgage,deed of trust or other encumbrance with a lien which has priority over this Mortgage to give Notice to Mortgagee,at Mortgagee's address set forth on page one of this Mortgage,of any default under the superior encumbrance and of any sale or other foreclosure action. IN WITNESS WHEREOF,Mortgagor has executed this Mortgage under Seal. 61-�al-' )-- 16��Kk� Patricia E.Hogan-Campbell COMMONWEALTH OF MASSACHUSEThS Barnstable,ss: On this I st day of December,2000,before me personally appeared Patricia E.Hogan-Campbell and-azknowlcdged the foregoing instrument to be his/herltheir free act and deed. / Donald F.fienderson-Notary Public My Commission Expires:3/28/2003 (Space Below This Line Reserved For Mortgagee and Recorder) My Corwlliss:nn Lrpires (.',arch 28,2003 BARNSTABLE REGISTRY If DEEQ$ CCB&T h362 5189 r Page 1 of 1 �► a a"� �j/�� itlf11YY'Ytiliilft3ff ift �.� All Records Abstract by Property Adr Property address: 1071 Shootflying Hill Road Doc type All document types - Town: Barnstable Start date: Stop date: 01011984 01012007 (mmddyyyy)� (mmddyyyy) Enter the Property Address in the O space provided above. D You may use either upper or lower case(it will be converted to upper O y case). 1 e o � http://199.232.150.242/ALIS/WW400R.HTM?WSIQTP=SY14D&WSKYCD=T 1/23/2007 ♦ .9 � �u��rIING =, p<In 'N HvOSTLANE O A FRgR qs O \ova 3 _o z m o < ` ♦ qS ANF °Ok tic v�o r y< ti o �Es <q�FF C�sl hFNRYF qY Fy�� a 2 v z wa212 1 OQ US �O o �o Z J tiF 4) /VF 20 eo U o O� �T MOONyP p°jNT DR O Q S ] W -� QPpP �/c F �P �o� RUSA- _ SS IICC W ENE MSH 7OUAOUE LAKE ! z UOUTG L S �; LANE G Z A r o O Q C b� �- �P4 A- m � c^ o AR DAV v OF,� O PGA !ROAD AN of w z C�, ti y� o� �2 ZOO WO AlF- v� 'p ;v �c5 r I G OHN i''r Q O G Z r- w r �, LANE CO NY z� � <r ROAD -0 �v`�o � LAO, �P G �vF` NEy z o z Q T ETSLN - ��d�N If I N/NC �c�� G 1 C�/FF ( R J LqRE T �p M �S H �I� •' N S CIR- o FY O �� zw. ivll� wAY RD p�Epp _ Z Zoo �P� e PP ASIs, AROADI �S� WPC y/ORy� Q o O<OJ� �uCROC REE� G4J�G GIN [` D�� eRIDG �o ( 3 o JP o V OP C 2' �' ROUTE 28 ,s'/"R%+�e e.►]i��jtJ�s��Fi��r �) R��`•3.�� 1� `•''•��/.7��1l3'u �. �ti� F°t��m. affy �l�q I r t•,'� 9 T ��I�'�ri, � v;r 1 •�.:;,�i'i��$� 't~. ,.i��?l��/(►'��*_� �/ � ��7��C'i `�� .. �1� / "�' +.ri:n' I..�'�%.�(��■ )`� � �`'C• ,��,, „ ��G.1v/ �Gpr�/I�tG, r � ��'11�i�.1�1/' �' ��-^mot J✓N51 �` 7 ' f�i7� ►��)� 1� � � ePsr F�traj*,la.,� fv.�. qU:.€e"�b1_ tiM(p.��' '�.r y... `ij\ _�wr�� zv✓,;ii" ��r� a �C,=q'� apt \� 1C' fi s maim, \ � 1� SNOB;'yr�ifwi, f�`.��i►�e��l+a F IY�� + ��1,� 'Ig�,j!e �Q �i' �1 �.'J� lF�.>� P' �, "r..fi• J� �► k i � ,nc�Mwr' `ar�L��' ��/,:r•�wrly� ��. :�1y •frx .sr, '�' �'��. ` r'.�r'�'�{—i��°"�C'o- a��s+,ra�iog.► 1 Apr. 10. 2007 12:44PM MASS DEP No. 2268 P. 1/5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 Riverside Drive, Lakeville, MA 02347 508 946-2700 DEVAL L.PATRICK IAN A BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN UTAONNE14L Lieutenant Governor Commissioner FAX COVER SHEET FAX # (508) 946-2865 TELEPHONE # (508) 946-2851 DATE: April 10, 2007 FROM: Roberta Edwards PLEASE DELIVER TO: Barnstable Board of Health 508 790 6304 ATTN: Donna Miorandi TOTAL NUMBER OF PAGES: 5 (INCLUDING COVER PAGE) . i I PLEASE CALL IF YOU DO NOT RECEIVE COMPLETE FAX. Notice of Response Action., 1071 Shoot Flying Hill Rd, Centerville This Information is available In alternate format.Call Donald M.Guuw%ADA Coordinator at 617-06.1057.TDD Service-1400-2994207. DEP on the World Wide Web: http:/Iwww.mass,gov/dep Printed on Recycled Paper AP r. 10. 2007 12:44PM MASS DEP No, 2268 P. 2/5 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL DEPARTMENT OF ENVIRONMENTAL UPRO (WY SOUTHEAST REGIONAL OFFICE IV 20 RIVERSIDE DRIVE,LAIEVII,LE,MA 02347 5 DEvAL L.PATRICK IAN A.BOWIES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Govemor Commissioner April 5,2007 Lauua Derosa RE:BARNSTABLE-BWSC/ASM 1071 Shoot Flying Hill Road 1071 Shoot Flying Hill Road,Centerville Centerville,Massachusetts 02632 RTN 4-20277 NOTICE OF RESPONSE ACTION Dear Ms. Derosa: The Department of Environmental Protection(MassDEP) has determined that there has been a release of oil and/or hazardous material at the above-referenced property. The release is a potential threat to groundwater. On January 22, 2007, you were issued a Notice of Responsibility (NOR) explaining your liability under M.G.L. c. 21E and responsibility to conduct response actions at the site in response to a release in excess of 200 gallons of#2 fuel oil. To date you have not conducted response actions on the site. On March 14, 2007 MassDEP installed 6-Small Diameter Monitoring Wells (SDMW)on the site. During the installation of the SDMW's,groundwater gauging did not indicate the presence of oil. MassDEP has determined that additional response actions are necessary to evaluate the threat to public health and the environment posed by the release and continuing threat of release of oil and/or hazardous material at the site. Beginning on or after April 23, 2007, MassDEP intends to conduct additional assessment activities at the site to determine the extent of the release that may pose an Imminent Hazard to health,public safety,welfare or the environment. In accordance with 310 CMR 40.0160,this notice is to provide you with the opportunity to agree to take the response actions described in this notification by the Interim Deadline established herein. STATUTORY LIABILITIES The following is a summary of your responsibility and liability under M.G.L.c.21 E. You are hereby advised that MassDEP has reason to believe that you (as used in this letter, "you"refers to Laura Derosa)are a Potentially Responsible Party(PRP)with liability under M.G.L. c. 21E, § 5,for response action costs. Section 5 makes the following parties liable to the Commonwealth of Massachusetts: current owners or operators of a site from or at which there is or has been a releaselthreat of release of oil or hazardous material; any person who owned or operated This inrormaGon Is available In altercate format CID Danald M.Games.ADA Coordiaator st 617456.1OS7.TDD Service-1•BOa295-22o'r. DEP on the World Wlde Web: http:/wrvw.masa.gtw/dep Printed on Recycled Paper f AP r. 10. 2007 12:44PM MASS DEP No. 2268 P. 3/5 CENTERVILLE-BWSUASM RTN 4-20277 Page 2 Notice of Response Action a site at the time hazardous material was stored or disposed of; any person who arranged for the transport, disposal, storage or treatment of hazardous material to or at a site; any person who transported hazardous material to a transport,disposal,storage or treatment site from which there is or has been a release/threat of release of such material; and any person who otherwise caused or is legally responsible for a release/threat of release of oil or hazardous material at a site. This liability is "strict", meaning it is not based on fault,but solely on your status as an owner, operator, generator, transporter or disposer. It is also joint and several, meaning that you may be liable for all response action costs incurred at the site,regardless of the existence of any other liable parties. The MCP requires responsible parties to take necessary response actions at properties where there is or has been a release or threat of release of oil and/or hazardous material. If you do not take the necessary response.actions, or fail to perform them in an appropriate and timely manner, MassDEP is authorized by M.G.L. c. 21E §4 to have the work performed by its contractors,and,by M.G.L. c. 21E §8 to enter any site and areas proximate thereto at reasonable times, and upon reasonable notice,to undertake assessment,containment and removal actions in order to address the subject release. Should you take the necessary response actions at the subject site, you can avoid liability for response action costs incurred by MassDEP and its contractors in performing these actions, and any sanctions which may be imposed for failure to perform response actions under the MCP. You may be liable for up to three (3) times all response action costs incurred by MassDEP. Response action costs include, without limitation, the cost of direct hours spent by MassDEP employees arranging for response actions or overseeing work performed by persons other than MassDEP or their contractors, expenses incurred by MassDEP in support of those direct hours, and payments to MassDEP's contractors. (For more detail on cost liability,see 310 CMR 40.1200.) MassDEP may also assess interest on costs incurred at the rate of twelve percent (12%), compounded annually. To secure payment of this debt, the Commonwealth may place liens on all of your property in the Commonwealth. To recover the debt,the Commonwealth may foreclose on these liens or the Attorney General may bring legal action against you. In addition to your liability for up to three (3) times all response action costs incurred by MassDEP, you may also be liable to the Commonwealth for damages to natural resources caused by the release. Civil and criminal liability may also be imposed under M.G.L. c. 21E, § 11, and civil administrative penalties may be imposed under M.G.L. c. 21A, § 16 for each violation of M.G.L.c. 21E,the MCP, or any order,permit or approval issued thereunder. INTERIM DEADLINE FOR NOTIFICATION OF YOUR INTENT TO CONDUCT RESPONSE ACTIONS As stated above, this letter provides notice to you that MassDEP intends to conduct the following additional response actions at the subject site unless you agree to do so in accordance with the terms and conditions of this notice. f Apr, 10, 2007 12:44PM MASS DEP v No. 2268 P. 4/5 CENTERVILLE-BWSC/ASM RTN 4-20277 Page 3 Notice of Response Acton An Immediate Response Action (IRA) should be conducted in accordance with 310 CUR 40.0420 which should include,but not be limited to: • ed be MassDEP Groundwater sampling of existingSmall Diameter MonitoringWells install )to determine extent of release and potential impact to groundwater. The date and time established for this submittal is an Interim Deadline established pursuant to 310 CUR 40.0167. MassDEP's decision to establish one or more Interim Deadlines in accordance with 310 CMR 40.0167 is not subject to M.G.L. c. 30A or any other law governing adjudicatory .proceedings. By this letter,MassDEP provides you the opportunity to perform the necessary response actions at the Site, as described herein, in lieu of MassDEP. If you do not take the necessary response actions, or fail to perform them in an appropriate and timely manner, MassDEP is authorized by M.G.L. c. 21E to perform the work. By taking such actions in lieu of MassDEP,you can avoid liability for response action costs incurred by MassDEP in performing these actions and any sanctions which may be imposed for failure to perform response actions under the MCP as described under the Statuary Liability section of this letter. Should you fail to voluntarily undertake the required response actions and provide MassDEP with the submittal required above by the established Interim Deadline, or should you provide submittals that are determined by MassDEP to be unacceptable, MassDEP will initiate these response actions and will initiate appropriate cost recovery and/or enforcement actions as described above. If at any time you wish to assume responsibility for these response actions after MassDEP has initiated them,you may do so only with the permission of MassDEP. Be advised that in addition to the specific response action requirements mentioned in this notification, you are responsible for conducting all additional 21E response actions which may be necessary to complete the cleanup of this site in accordance with the MCP. The subject site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the site have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c. 21E and the MCP. These response actions may include but are not limited to Comprehensive Response Actions and additional Immediate Response Actions. MassDEP encourages PRPs to take prompt action in response to releases and threats of release. of oil and/or hazardous material. By taking prompt action, PRPs may significantly lower their assessment and cleanup costs and avoid the imposition of, or reduce the amount of, certain permit and annual compliance fees for response actions payable under 310 CMR 4.00. If you have any questions relative to this notice,you should contact Michael Whiteside at(508) 946-2704 or at the letterhead address. AP r. 10. 2007 12:45PM MASS DEP No. 2268 P. 5/5 CENTERVILLE-BWSC/ASM RTN 4-20277 Page 4 Notice of Response Action You should notify MassDEP in writing no later than 5:00 p.m. on April 20, 2007 if you intend to conduct the required response actions. Very truly yours, Dan Crafton,Acting Chief Emergency Response/Release Notification Section P/MCW/re 4-20277/no0ce*%pmRact1on.doc CERTIFIED MAIL#7006 2760 00015208 7661 cc: Ardito, Sweeney, Stusse,Robertson&Dupuy,P.C. Attorneys at Law,ATTN: Matthew J.Dupuy 25 Mid-Tech Drive, Suite C West Yarmouth,Massachusetts 02673 ec: MassDEP-Boston ATTN:Thomas Potter,BWSC-DRR-AUD MassDEP-SERO Data Entry fc: Barnstable Board of Health ATTN:Donna Miorandi Jan. 29, 2007 9: 30AM MASS DEP No. 1379 P. 1/4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20 Riverside Drive, Lakeville, MA 02347 608 946-2700 DEVAL L PATRICK IAN A BOWLES Governor Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner FAX COVER SHEET i FAX # (508) 946-2865 TELEPHONE # (508) 946-2851 i DATE:'January 29, 2007 FROM: Roberta Edwards PLSASS DELIVER TO: Barnstable Board of Health 508 790 6304 Barnstable Board of Selectmen 508 790 6226 TOTAL NUMBER OF PAGES: 4 (INCLUDING COVER PAGE) PLEASE CALL IF YOU DO NOT RECEIVE COMPLETE FAX. Laura Derosa, 1071 Shoot Flying Hill Road c 1 cz� C\' " 1 I This information ib available In alternate format Call Donald M.Carnes,ADA Coordinator at 617dd61057.TDD Service-1.60&2994207. f DEP on the World Wide Web: hW/Miww.mass.gcw1dap Pdntad on Retiyoled Paper I� I 4 Jan, 29. 2007 9: 30AM MASS DEP No. 1379 P. 2/4 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PR �1 1 SOUTHEAST REGIONAL OFFICE 20 RIVERSIDE DRIVE,LAKEVILLE,MA 02 DEVAL L.PATRICK IAN A BOWLES Governor • Secretary TIMOTHY P.MURRAY ARLEEN O'DONNELL Lieutenant Governor Commissioner URGENT LEGAL MATTER:PROMPT ACTION NECESSARY January 22,2007 Laura Derosa RE: CENTERVILLE-BWSC 1071 Shoot Flying Hill Road 1071 Shoot Flying Hil I Road Centerville,Massachusetts 02632 RTN#4-20277 NOTICE OF RESPONSIBILITY M.G.L c.21E,310 CMR 40.0000 ATTENTION:Laura Derosa On January 19, 2007 at 6:16 pm the Department of Environmental Protection ("MassDEP") received notification indicating that a release of oil and/or hazardous material has occurred at the location referenced above. It was reported that 160 gallons of# 2 Fuel Oil was released from an above ground storage tank located adjacent to the residential dwelling. The Massachusetts Oil and Hazardous Material Release Prevention and Response Act, M.G.L. c.2IE, and the Massachusetts Contingency Plan (the "MCP"), 310 CMR 40.0000,require the performance of response actions to prevent harm to health, safety,public welfare and the environment which may result from this release and/or threat of release and govern the conduct of such actions. The purpose of this notice is to inform you of your legal responsibilities under State law for assessing and/or remediating the release at this property. For purposes of this Notice of Responsibility,the terms and phrases used herein shall have the meaning ascribed to such terms and phrases by the MCP unless the context clearly indicates otherwise. MassDEP has reason to believe that the release.and/or threat of release which has been reported is or may be a disposal site as defined by the M.C.P. MassDEP also has reason to believe that you(as used in . 1 this letter, "you" refers to Laura Derosa)are a Potentially Responsible Party(a"PRP")with liability under 1 M.G.L. c.21.E §5, for response action costs. This liability is "strict",meaning that it is not based on fault, but solely on your status as owner, operator, generator, transporter, disposer or other person specified in M.G.L. c.2lE §5. This liability is also "joint and several',meaning that you may be liable for all response action costs incurred at a disposal site regardless of the existence of any other liable parties. I This information is available in alternate formal.Call Donald M.Gomm ADA Coordinator at 617-556.1057.TDD Service-1.800.298.2207, DEP on ihs World Wids Web:.htlp:Uwww.mssa.gov/dep Printed on Recyded Paper Jan. 29, 2007 9: 30AM MASS DEP No. 1379 P. 3/4 2 MassDEP encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous materials. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the MassDEP in taking such actions. You may also avoid the imposition of, the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L. c.21E is attached to this notice. You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. MassDEP encourages you to take any action necessary to protect any such claims you may have against third parties. 5D EDIATE RESPONSE ACTIONS At the time of notification,MassDEP provided verbal approval to conduct the following Immediate Response Actions: • Employ a Licensed Site Professional to determine extent of release. • All Remediation Waste must be properly stored/handled and disposed of within 120 days from the date of generation per 310 CMR 40.003 0. REQUIRED ACTIONS In addition to oral notification, 310 CMR 40.0333 requires that a completed .Release notification Form (BWSC-103, attached) be submitted to MassDEP within sixty (60) calendar days of Janaury 19, 2007. You must employ or engage a Licensed Site Professional(LSP)to manage, supervise or actually perform the necessary response actions at this site. You may obtain a list of names and addresses of LSPs from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling (617) 556-1091 or visiting http://www.state.ma.usAsp A homeowner who is conducting response actions at his or her residence to address a release of oil and who meets the definition established in 310 CMR 4.02 qualifies for reduced permit and annual compliance fees. A homeowner per 310 CMR 4.02 is an owner occupant of a residential one to four family structure used exclusively as a residence(s) throughout his or her ownership, where the owner's unit is the owner's principle residence for six or more months of the year and where the owner is conducting response actions. A completed Homeowner Certification Transmittal Form (BWSC120, attached)must be submitted to be eligible for the reduced fees. Additional submittals are necessary with regard to this notification including,but not limited to,the j filing of a written IRA Plan, IRA Completion Statement and/or a Response Action Outcome (RAO) statement. The MCP requires that a fee of $1200.00 be submitted to MassDEP when a RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the MassDEP for the implementation of all IRAs pursuant to 310 CMR 40.0420. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. I Jan. 29. 2007 9: 30AM MASS DEP No, 1379 P. 4/4 3 Unless otherwise provided by MassDEP, potentially responsible parties ("PRP's") have one year from the initial date of notification to MassDEP of a release or threat of a release, pursuant to 310 CMR 40.0300,or from the date MassDEP issues a Notice of Responsibility,whichever occurs earlier,to file with MassDEP one of the following submittals: (1) a completed Tier Classification Submittal; (2) an RAO Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is January 19, 2008. If required by the MCP, a completed Tier I Permit Application must also accompany a Tier Classification Submittal. This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release have been eliminated and a level of No Significant Risk exists or has been achieved in compliance with M.G.L. c.21.E and the MCP. MassDEP prepared the Homeowner Oil Spill Cleanup Guide .to assist homeowners in understanding the legal requirements and step-by-step cleanup procedures of the MCP. The Guide will familiarize you with the terminology, parties involved, cleanup technologies etc. The Guide is available at the Regional Office or at http://mass.gov/dep/bwsc/fiiles/bomeownr/homeownr.htm. If you have any questions relative to this Notice,please contact Michael Whiteside at the letterhead address or at (508) 946-2704. All future communications regarding this release must reference the following Release Tracking Number:4-20277. Very truly yours, Daniel Crafton,Acting Chief Emergency Response/Release Notification Section P/MCW/ Attachments: Summary of Liability under M.G.L.c.21E Homeowner Certification Transmittal Form(BWSC120) cc: Board of Selectmen Board of Health Fire Department i oF1HE The Town of Barnstable STAB . * Office of Town Manager �6 367 Main Street, Hyannis, MA 02601 RFD MA'S A www.town.barnstable.ma.us Office: 508-862-4610 John C. Klimm,Town Manager Fax: 508-790-6226 Email: john.klimm@town.barnstable.ma.us i MEMORANDUM TO: Tom Geiler Ruth Weil Tom McKean✓ Mark Ells FR: John C. Klimm, Town Manager DT: 1/31/07 RE: Laura Derosa For your information, I am forwarding you correspondence on the above-mentioned matter. Thank you JCK:Ids IJaii- L7. LUUI 7; )7HIVI IVIIIJJ u t r IVo. Ijly r, COMMONWEALTH OF MASSACHUSETTS +, EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION SOUTHEAST REGIONAL OFFICE 20,Riverside Drive, Lakeville, MA 02347 508 946-2700 DEVAL L.PATMCK Governor LAN A BOWLES Secretary TIMOTHY P.HURRAY Lieutenant Governor ARLEEN 9DONNELL Commissioner FAX COVER SHEET FAX # (508) 946-2865 TELEPHONE # (50B) 946-2851 DATE: January 29, 2007 FROMs Roberta Edwards PLEASE DELIVER .TO: Barnstable Board of Health 508 790 6304 Barnstable Board of Selectmen 508 790 6226 TOTAL NMdBER OF PAGES t 4 (INCL=ING COVER PAGE) PLEASE CALL IF YOU DO NOT RECEIVE COMPLETE FAX. Laura Darosa, 1071 Shoot Plying Hill Road I i f I i This id0rmatio9 is avallabie in aiteroate formaL Call Donald M.Goma,ADA Coordinator at 617'556-1057.TDD Service-1.800.2984y07. f DEP on the Wodd Wide Web: htip:1Awww,m=.gcv1dep i Printed on Regfded Paper i f! fI No, 1379 P. 214 COMMO NWEAUTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVlRO 1 I t REPARTMENT OF ENVIRO N�'AI•AFF SOUTHEAST REGIONAL OFFICCE ENTAL j�� ZO RNERSYDE DRIVE LAKE .MA 02 DEVAL L.PAMCK Governor TIMOTHY P.M T lZAy IAN A BOWLES Lieutenant Governor Secretary a , ARLUN O'DONNELL Commissioner URGENT LEGALMATTER-PROMPT ACTION NECE SS January 22,2007 Laura.Derosa 107I Shoot Flying Hill Road RE: CENTERVILLE_ SC Centerville,Massachusetts 02632 1071 Shoot Flying Hill Road RTN#4-20277 NOTICE OFRESPONSIBILI7y M.G.L. G 21B,31D CYIR 40.0000 ATTENTION:Laura Derosa On January 19, 2007 at 6:16 m received notification indicating that a release ho of oiDl and/or partment of Environmental Protection ("MassDEP") referenced above, It was reported that 160 hazardous material has occu>red at the location stora a gallons of# 2 Fuel Oil was released from above g tank located adjacent to the residential dwelling. ground j The Massachusetts Oil and Hazardous a21E, and the Massachusetts Continge plan atrial Release Prevention and Res onse Ac of response actions to prevent harm to heal ( MCP )' 310 CMR 40.D000 require the t' M.G.L. from this release and/or threat of release and govern the conduct R h may performance tY,public welfare and the environment which may result is to inform you of your legal responsibilities under State law for assessing actions. The this P"OPerty. For purposes of this Notice ofp sating of this notice the meaning For to such terms and phrases besponsibility, the terms ad��remediating the releaSe at y the MCP unless the context clearly indicates es used lot}�e ,.n shall have MassDEp has reason to believe that the otherwise, ise, een or may be a disposal site as defined by the M•C•p Feat of release which h as this letter " ++ MassDEP also has reason to believe that you(as used in . You refers to Laura Derosa) are a potentially Responsible P M•G•L• Teliorted is 0,2].>✓ §S, for response action costs. This liability is ,strict,, rnea'rtY�a ,.pRp but solely on yow status as o )with liability under caner, operator amng that it is not based on fault, M.C.L. c.21E §5. This liability is also + ' generator, transporter, disposer or other action costs incurred at a disposal site regardless of the existence in person specified in joint and several",meaning that you may be liable for all response an other liable parties, This information is available in altornale format Call Doold IM Gomea,ADA Coordinator at 617-33G 1037.TD + I DEP on the Wolltl Wide Web: •ht! :/ D Service.1-800.2982207, P hvwW.maea,gov/deP Pdnted on Recycled Paper i V I / J V r 1 r r 1 I 1 1 V V ULI INV, 2 MassDEP encourages parties with liabilities under M.G.L. c.21E to take prompt and appropriate actions in response to releases and threats of release of oil and/or hazardous material§. By taking prompt action, you may significantly lower your assessment and cleanup costs and/or avoid liability for costs incurred by the MassDEP in taking such actions. You may also avoid the imposition of, the amount of or reduce certain permit and/or annual compliance assurance fees payable under 310 CMR 4.00. Please refer to M.G.L. c.21E for a complete description of potential liability. For your convenience, a summary of liability under M.G.L.c.21E is attached to this notice: You should be aware that you may have claims against third parties for damages, including claims for contribution or reimbursement for the costs of cleanup. Such claims do not exist indefinitely but are governed by laws which establish the time allowed for bringing litigation. MassDEP encourages you to take any action necessary to protect any such claims you may have against third parties. DRIEDIATE RESPONSE ACTIONS At the time of notification,MassDEP provided verbal approval to conduct the following Immediate Response Actions: • Employ a Licensed Site Professional to determine extent of release, • All Remediation Waste must be properly stored/bandied and disposed of within 120 days from the date of generation per 310 CMR 40.0030, REQUIRED ACTIONS In addition to oral notification, 310 CMR 40.0333 requires that a completed Release notification Form (BWSC-103, attached) be submitted to MassDEP within sixty (60) calendar days of Janaury 19, 2007. You must employ or engage a Licensed Site Professional(LSP)to manage, supervise or actually perform the necessary response actions at this site, You may obtain a list of names and addresses of LSPs from the Board of Registration of Hazardous Waste Site Cleanup Professionals by calling (617) 556-1091 or visiting http://www.state.ma.usAsp A homeowner who is conducting response actions at his or her residence to address a release of oil and who meets the definition established in 310 CMR 4.02 qualifies for reduced permit and annual compliance fees. A homeowner per 310 CMR 4.02 is an owner occupant of a residential one to four family structure used exclusively as a residence(s) throughout his or her ownership,where the owner's unit is the owner's principle residence for six or more months of the year and where the owner is conducting response actions A completed Homeowner Certification Transmittal Form (BWSC 120, attached)must be submitted to be eligible for the reduced fees. Additional submittals are necessary with regard to this notification including,but not limited to,the I filing of a written IRA Plan, IRA Completion Statement and/or a Response Action Outcome (RAO) statement. The MCP requires that a fee of $1200.00 be submitted to MassDEP when a RAO statement is filed greater than 120 days from the date of initial notification. Specific approval is required from the MassDEP for the implementation of all IRAs pursuant to 310 CMR 40.0420. Assessment activities, the construction of a fence and/or the posting of signs are actions that are exempt from this approval requirement. I i I I vun, L. Lvv i ..vvruri irinvu uLI IN. 1317 f, `t/ t 3 Unless otherwise provided by MassDEP, potentially responsible parties ("PRP's") have one year from the initial date of notification to MassDEP of a release or threat of a release, pursuant to 310 CMR 40.0300, or from the date MassDEP issues a Notice of Responsibility,whichever occurs earlier, to file with MassDEP one of the following submittals: (1) a completed Tier Classification Submittal; (2) an RAO Statement or, if applicable, (3) a Downgradient Property Status. The deadline for either of the first two submittals for this disposal site is January 19, 2008. if required by the MCP, a completed Tier i Permit Application must also accompany a Tier Classification Submittal, This site shall not be deemed to have had all the necessary and required response actions taken unless and until all substantial hazards presented by the release and/or threat of release.have been eliminated and a level of Na Significant Risk exists or has been achieved in compliance with M.G.L. c.21E and the MCP. MassDEP prepared the Homeowner Oil Spill Cleanup Guide to assist homeowners in understanding the legal requirements and step-by-step cleanup procedures of the MCP. The Guide will familiarize you with the terminology, parties involved, cleanup technologies etc. The Guide is available at the Regional Office or at http://mass.gov/dep/bwse/files/bomeowu/homeownr.htm. if you have any questions relative to this Notice,please contact Michael Whiteside at the letterhead address or at (508) 946-2704. All future communications regarding this release must reference the following Release Tracking Number:4-20217. Very truly yours, �Oln� Daniel Crafton,Acting Chief Emergency Response/Release Notification Section P/MCW/ Attachments: Summary of Liability under M.G.L. c.21E Homeowner Certification Transmittal Form(BWSC120) cc: Board of Selectmen Board of Health Fire Department i i 1 oFT"E�w,ti Town of Barnstable f�. -�• U.S.P�TAGE Public Health Division # ��PITNEYBOWES Hyannis,O MainMA 02601 0ZIP 2 02601OV cO��++ `. 0000.336455pO�v-2018 � 7008 3230 0002 5177 8001 i l ( "1 CAMPBELL, MATTHEW W$JENNIFER E 1071 SHOOTFLYING HILL ROAD —_�_ � � _l;.FNTC�\/I1.�.•C„nnn,n�cnn,Y'— ,+ ��11________ 0.-4.3 .eN S` ` t ' UNCLAIMED UNABLE TO FORWARD a2Eah yaoera. ! tt1tt1114lttlt11111111111 till III ct1111ett111tt111i1t1tt1rttlr111i . { — /. fi s e a+e eat i e a r SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY \ I ■ Complete items 1,2,and 3. A. Signature ■ Print your name and address on the reverse X ❑Agent so that we can return the card to you. ❑Addressee ; I ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery ` I or on the front if space permits. 1. D: Is delivery address differenf from-item 1? ❑Yes If YES,enter delivery address below: ❑No I CAMPBELL, MATTHEW W&JENNIFER E - 1071 SHOOTFLYING HILL ROAD I CENTERVILLE, MA02632 I 3. I / I II I IIII'I IIII II I II I II II II I III II III III II II I III El❑Ad Service gn Signature ❑ReegisterMail ed Ma Mess® \ 1 u t Signature Restricted Delivery ❑Registered Mall Restricted 9590 9402 4116 8092 9358 31 r ified Mail® �Derivery Lr]Certified Mail Restricted Delivery q f:tum Recelpt for ❑Collect onDelivery \Merchandise i 9__Artirle Number[Transfer from,service-iahe0 Delivery Restricted Delivery ❑Signature ConfirmationTm Collect on ❑.Signature Confirmation l� 7008 3230 0002 5177 8001 -__Jj I Restricted Delivery Restricted Delivery � PS Form 384131,tJuly 2015 PSN 7530-02 000 9053 Domestic Return Receipt �� Town of Barnstable Barnstable P` tio� Ai-AmedcaQty Inspectional Services aAlNVAB qp fb3q. ,� Public Health-Division . 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 CERTIFIED MAIL#7008 3230 0002 5177 8001 December 28, 2018 CA_MPBELL, MATTHEW W& JENNIFER E 1071 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1071 Shootflying Hill Road (Rear System), Centerville, MA, was inspected'on 11/17/2018 by Sean M. Jones, 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: • Cesspool is lacking structural integrity. You are ordered tdrepair or replace the septic system within two (2)years from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF.HEALTH s c dean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1071 Shootflying Hill Road(Rear House System)Centerville.doc �P D�p,�y1lMgEyyT�O�i Town of Barnstable f y' U.S.POSTAGE>>PITNEYBOWES I.T, Public Health Division Y RARMSATAB LE.g 200 Main Street i t�4 N, 4'pfED MP+a 0 Hyannis,MA 02601 r 1 ZIP 260102 YV �` oOC'C t0 0004 03.36455 DEC. 28, 2018, P 7008 3230 0002 51177 7998 CAMPBELL, MATTHEW W&JENNIFER E 1 U 1071 SHOOTFLYING HILL ROAD � 1 CENTERVILLE, MA 02632 _ RETURN TO SE N DE R 6 no u N cl_Al IM E D UNABLE TO =01VdARD A. 4a+R�,e - �.1'�'Yt:,•�. 9 }: 4t 1 1tf )ts Bl}tS3 4Af9t 9a }33i 19_dS d7 d 00— , SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION DIV DELIVERY, _ I ■ Complete items 1,2,and 3. A Signature ■ Print your name and address on the reverse X ❑Agent I so that we can return the card to you. ❑Addressee ■ Attach this card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery or on the front if space permits. 1 -— -- D. Is delivery address different from item 1? ❑Yes If YES,enter delivery address below: ❑'No CAMPBELL, MATTHEW W&JENNIFER E� 1071 SHOOTFLYING HILL ROAD I CENTERVILLE, MA 02632 I II I IIIIII IIII III I II I II II II III II III III I Ili)III 3�Coervice Type ❑Priority M ail Express® Adult signature Registered OE It Signature Restrcted Delivery ❑Registered Mail Restricted ted ❑certified Mail® luery 9590 9402 411E 8092 9358 24 Certifed Mail Restricted Delivery xDeturn Receipt for lleetonDelivery Merchandise ) �� `\ I ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT"' j I 7_Adir.le Numtie[,(Transfer from-service label) Karl ❑Signature Confirmation 7 0 0 8 3 2 3 0 0002 517 7 7998 it Restricted Delivery Restricted Delivery t Return R \ e PS Form 3811,July 2015 PSN.7530-02-000-9053 Domestic a urn Receipt - - - c. �ftrtir:ram, Town of Barnstable Barnstable Inspectional Services �NnericaCihly �AerrscAUm. NAM- 1639. ��$ - Public HealthDivision- -- - -------- - pr�° 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas A.McKean,CHO FAX: 508-790-6304 r CERTIFIED MAIL47008 3230 0002 5177 7998 December 28, 2018 CAMPBELL, MATTHEW W &JENNIFER E - ~ -- 1071 SHOOTFLYING HILL RD' --' ------- - _ _ _ CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1071 Shootflying Hill Road (Main House), Centerville, MA,was inspected.on-l1/17/2018 by.Sean M. Jones, 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: 0 Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. You are ordered to repair or replace the septic system within one (1)year 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 c S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1071 Shootflying Hill Road(Main House System)Centerville.doc THE COMMONWEALTH OF MASSACHUSETTS BOARD 7, HEALT Application is hereby made for a Permit to Construct or Repair an Individual Sewage Disposal Aor Location s Address ....................... cil-z I t� Installer Address Other Distribution box ( ) Dosing tank ( ) 0 Description of Nature of Re The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Sigied Date Application Disapproved for the following reasons:...................................4;-------------------------------------------- ------------------------------ � ---`--'-----'--------`--`----`-----------`---------'--`----------------------- n"te Permit No. Issued...' Date No.- s.... F��.... .................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALT _ ........OF....... .... .. .�t�...._..-.• .. Apphrtation -for M-4poiittl Workfi Tonfitrurtion Vrraaait Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal Sys "WW Lt ion-A .. _ -- / a - vocat Lot o. v caner v / Address a % �- Installer Address UType of Buildin Size Lot............................Sq. feet �-, Dwelling o. of Bedrooms--------------------------------------------Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) a' Other fixtures W Design Flow--- ----------------------------------------gallons per;person per day. Total daily flow............................................gallons. WSeptic Tank iquid capacity.I allons Length---------------- Width---------....... Diameter-----...._.----- Depth................ xDisposal Trench—No..................... Width-------------------- Total Length-------------------- Total leaching area-.--.---_--_._-__--sq. ft. Seepage Pit No...._..___7 Diameter____________________ Depth below inlet.................... Total leaching area---------.._-__--sq. ft. z Other Distribution box ( ) Dosing tank ( ) PercolationTest Results Performed by-------------------------------------------------------------------------- Date............................--------.... Test Pit No. 1----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water._------.--.---_.-_..- LXq Test Pit No. 2................minutes per inch Depth of Te-t Pit ............... Depth to ground water------------------------ 19 --••--•. ---------------------------------------------------------------------------------- ODescription of Soil - �'` `z/ -�'t -A---_---_---- -----•--------------------•------•----•-------------- x ----------------------............................................................................... .............. - ----... F........... , U Nature of Repairs or Alter ions—Answer when applicable.- --------------- t ._... ----------••- -------pl n---------- ..J -- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health. Signed ----- Date Application Approved B Date Application Disapproved for the following reasons:----- -•----------- ........................................................... -------------•-------•--•----------------------------•---------•---.-----•--•--------•----•----------•-------------------------------•------•------------------.----•--------------•-------------------- Date PermitNo........................................................ Issued.................................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF EALTH �...... .. . .........OF......... .... .. .. .......................................... (Trrtifiratr of Tontplia urr THIS I CER" IFY, t t e Indivi 1 ewage Disposal System constructed ( ) or Repaired (� .. .`----------- t by....... ✓/� In all , has been installed in accordance with the provisions of Article XI of The S to Sa ' ary Code as described in the application for Disposal Works Construction Permit No----------------------------------------- dated..... /'_. :7. .................... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUE© AS A GUARANTEE THAT TIME SYSTEM IL FUN TION S TISFACTORY. f DATE Ae --- 7--- - ---------------••-••-----•--...... Inspector------- -------- ... "_---_�---- THE COMMONWEALTH OF MASSACHUSETTS BOARD F HEALTH ..................... No............ ------------- FEE----- ..----....--- Rispoiittl ork notratrtt rranit Permission is hereby granted--- -- 1: 1 =---------------------------------- ------ to Const u t ( ) Repair (�an Individual S wag sal system / a /�'I . . Str et as shown on the application for Disposal Works Construction 0.____.. - ............... . .............. / ------ -----• --- ......... oar o ealth G� DATE.... `-...�.--- .............................................. FORM 1255 HOBBS & WARREN. INC.. PUBLISHERS /ab � z: 40,CATION 1 SEW GE PERMIT NO.. -� h °° LYi� 1��J1 '7 � "'ILL GE re-Y V ! 1 O INSTA LL R'S NAME & A.DDRESS B U1*LDE It OR OWNER 29 -e Y l DATE PERMIT ISSUED DATE COMPLIANCE ISSUED —� 1 � o � c�. � - . 9 n ,� ;�� , �a fb � � .� f - 97--EXISTING CONTOUR N x 100.98 EXISTING SPOT GRADE W EXISTING WATER SERVICE LCP 24654 A o H. W-OVERHEAD WIRES Mon Penny o Ln TEST PIT �, o BENCHMARK Cr 26 28' N 05-37'10" E o a ♦ c Mene 2 LEGEND ` 73 75' sho Ln \ Y O O \ t \ N C LOCUS \\ x 95.03 ♦ pve ♦♦ \♦ Woodvole Ln o Co\1's ♦ `_ 0 \ \ Carleton wilco, In 2, 6LOT0 to x 92.76 n LOCUS MAP 0.74±AC-- \ t ' NOT TO SCALE 89.46 x� t t ! J EXISTING SEPTIC TANK-2 J �� TOP OF TANK, EL.=87.75 IN V.(IN)=86.65f(VERIFY) r INV.(OUT)=86.40t(VERIFY) x 88.12 I EXISTING CESSPOOL TO BE PUMPED, FILLED I J... .� W/SAND & ABANDONED PROPOSED S.A.S. 2-500 1. o ..�,�� SURROUNDEDO W/4'ASTOBERS �., o .'' 89.46 y, 3 1 60 \\TP-1 Z rr� ,GARAGE TP-2x 90.63 N �p / w c) NI W/BATHROOM 11 T.O.S.=89.6t 1 v 1 89.62 _89:50. :: INTALL CLEANOUT <8 .55' ESTIMATED LOCATION OF 1 a EXISTING WATER SERVICE BETWEEN HOUSE & GARAGE x 90.86 90.70 EXISTING LEACH PITS t PAi/ED:. .° :I.r.,;.: BENCHMARK ;'DRl v�WAY I MAGNETIC NAIL SET CONTRACTOR SHALL PUMP, \ { I:':;'" M91.20 L FILL WITH SAND & ABANDON 91.2o EL.=91.20 SAW CUT PAVEMENT EXISTING SEPTIC TANK-1 \ x 92.72 ��_�- i (H-10, os determined in field) 91.65 i INV.(OUT)=89.5f(VERIFY) 1 96.4 x 92.16 1 / � I '.> DRIVEWAY TO BE MODIFIED TO PREVENT DEW. VEHICLES FROM DRIVING OVER IT. x 93.11 92.99 (obove)1 100. 7\ i 92.85`=. 92.6 KOUT l' iEX/STING 10. 3 x �� HOUSE(#1071) 1 100.05♦\ CELLAR FL=93.7± /100.79 x 93.92 1 .89 101.04 x 00 5 ` 95:61 ' 10 .00 \l 1 I I 1101.99 I I 9 51 -01.32 I 1 1 1 1 p'. 101.33 1 ':.Cz�i. . 9. 4 / Z 100-w 97.92 99.40 99.17 98.55 59 S -j T( NG 97.19 8 HOO�l L 1 PLAN REVISION 5 f 28/19 HILL .RpAD PROPOSED DRIVEWAY ALTERATION PARCEL ID: 191 -026 Of M gssq�y� PETER T. �, PROPOSED SEPTIC SYSTEM UPGRADE PLAN McENTEE 1071 SHOOTFLYING HILL RD, CENTERVILLE, MA CIVIL No. 35109 Prepared for: AU Realty Corp, 128 Main Street, Hyannis, MA 02601 IS�ER�O Engineering by: SCALE DRAWN JOB. NO. ALJ REALTY CORP 9 g ' I � OWNER RECORD Engineering Works, Inc. 1"=30' P.T.M. 167-19 128 MAIN STREET 12 `West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. HYANNIS, MA 02601 (508) 477-5313 5/10/19 P.T.M. 1 of 2 ' 3 SEPTIC TANK-1 NOTE: TO PREVENT BREAKOUT, THE PROPOSED INSTALL RISERS & COVERS OVER INLET FINISH GRADE SHALL NOT BE < EL:86.27 AND SET TO 6" OF FINISH GRADE. FOR A DISTANCE OF 15' AROUND THE SEPTIC TANK-2 PERIMETER OF THE S.A.S. PROPOSED S.A.S. INSTALL H-20 RISERS, FRAMES & COVERS OVER INLET PROPOSED D-BOX PROVIDE TWO ACCESS MANHOLES TO WITHIN 3" & OUTLET TEES, SET E GRADE. WARE ACCESS. SHALL INSTALL WATERTIGHT RISER & OF FINISH GRADE FOR INSPECTION PURPOSES BE SECURED TO PREVENT UNAUTHORIZED ACCESS. COVER SET TO 6" OF GRADE T.O.F.=VARIESt F.G. EL.=90.6t F.G. EL.=VARIESt F.G. EL.=89.5t F.G. EL.=90.Ot MAINTAIN 2% GRADE (MIN.) OVER S.A.S. SEE _ L. = 111' NOTE L1 - 114' L2 - 22' L = 5' SCH4 (MIN.) ABOVE p S=l% (MIN.) p S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC 6" ee I "I 6 8Ba9a8B 14" aaaaaaa INV.=86.65t 48" LIQUID aaaaaaa (VERIFY) LEVEL ADD 4' 4.8' 4' GAS BAFFLE INV.=86.18 PROPOSED INV.=86.01 INV.=89.50t D-BOX EFFECTIVE WIDTH = 12.8' EXISTING SEPTIC TANKS ST-1 INV.=85.78 INV.=86.40t 3-500 GALLON LEACHING CHAMBERS ST-1(1000 GAL), ST-2(1500 GAL) SURROUNDED WITH STONE AS SHOWN ST-2 - PROPOSED SEWER CONNECTION (VERIFY) H-10 RATED INV.=89.8t (VERIFY) TOP CONC. ELEV.=87.6t BREAKOUT ELEV.=86.27 JI NOTES: INV. ELEV.=85.78 a aaaaat,310013 aaaa If 1) CONTRACTOR SHALL VERIFY ALL EXISTING PIPE aaaa aa Ba E ) INVERTS, PRIOR TO INSTALLATION. BOTTOM ELEV.=83.78 4' J 3 x 8.5'=25.5' 4' 2) D-BOX SHALL BE SET LEVEL AND TRUE TO GRADE 4' MIN. OF NATURALLY OCCURRING EFFECTIVE LENGTH = 33.5' ON A MECHANICALLY COMPACTED SIX INCH CRUSHED PERVIOUS MATERIAL STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2). 5' MIN. ABOVE GROUNDWATER _LEACHING SYSTEM SECTION 3) INSTALL INLET & OUTLET TEES AS REQUIRED. BOTT. OF TP, EL.=78.8 - 4) CONTRACTOR SHALL INSTALL A GAS BAFFLE ON 3/4" TO 1-1/2" DOUBLE THE OUTLET TEE. WASHED STONE 3" LAYER OF 1/8" TO 1/2" SEPTIC SYSTEM PROFILE DOUBLE WASHED STONE (OR APPROVED FILTER FABRIC) 12 8' GENERAL NOTES: 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL 1 1 BOARD OF HEALTH AND THE DESIGN ENGINEER. N 1_ 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS 1 0 rn 1'n OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE 1 a. Q 1''i LOCAL RULES AND REGULATIONS. 3. THE SEWAGE DISPOSAL SYSTEM.SHALL NOT BE BACKFILLED PRIOR i TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 1 J DESIGN ENGINEER. 24.3' tO _. 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING FROM THOSE SHOWN HEREON SHALL BE, REPORTED TO THE DESIGN Z ENGINEER BEFORE CONSTRUCTION CONTINUES. GARAGE bi 5. ALL ELEVATIONS BASED ON ASSUMED DATUM (BARNSTABLE G.I.S.f). T.OS.896E IQ M 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. 24.3' 7. WATER SUPPLIED BY TOWN WATER SERVICE. 8. THERE ARE NO WELLS WITHIN 150' OF THE PROPOSED S.A.S. SEPTIC LAYOUT 9. ALL AREAS CLEARED FOR CONSTRUCTION SHALL BE RESTORED AS AGREED UPON BY OWNER AND CONTRACTOR OR AS OTHERWISE DIRECTED BY THE APPROVING AUTHORITIES. 10. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY SOIL LOG THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING CONSTRUCTION. DATE: APRIL 30, 2019 (REF#15,963) 11. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL UNSUITABLE SOILS SOIL EVALUATOR: PETER MCENTEE PE(SE#1542) IN THE AREA BENEATH AND FOR 5' ON ALL SIDES OF THE S.A.S. AND WITNESS: DAVID STANTON R.S. HEALTH AGENT REPLACE WITH CLEAN SAND AS SPECIFIED IN 310 CMR 255(3). 12. AREAS REQUIRING STRIPOUT OF UNSUITABLE MATERIALS SHALL BE ELEV. TP-1 DEPTH ELEV. TP-2 DEPTH INSPECTED BY A LICENSED SOIL EVALUATOR PRIOR TO BACKFILL. 89.8 A 0" 90.2 A 0" 13. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY AND LOAMY SAND LOAMY SAND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. 10YR 4/2 10YR 4/2 89.0 B 10" 89.5 B 8" LOAMY SAND LOAMY SAND 1OYR 5/4 10YR 5/4 87.3 30" 87.9 28" C1 C1 COARSE SAND PERC COARSE SAND DESIGN CRITERIA 2.5Y 6/4 "/58„ 2.5Y 6/4 40 >10% GRAVEL >10% GRAVEL NUMBER OF BEDROOMS: 4 SOIL TEXTURAL CLASS: CLASS I 84.3 60" 85.2 60" C2 C2 DESIGN PERCOLATION RATE: <2 MIN/IN (0.74 GPD/SF LOADING RATE) M-C SAND M-C SAND DAILY FLOW: 440 GPD 2.5Y 6/6 2.5Y 6/6 DESIGN FLOW: 440 GPD <10% GRAVEL <10% GRAVEL GARBAGE GRINDER: NO LEACHING AREA REQUIRED: (440 GPD) = 594.6 SF .74 GPD/SF 78.8 132" 79.2 132" EXISTING SEPTIC TANK-1: 1000 GALLON CAPACITY NO GROUNDWATER OBSERVED EXISTING SEPTIC TANK-2: 1500 GALLON CAPACITY PERC RATE: <2 MIN./IN., "C" HORIZONS PROPOSED DISTRIBUTION BOX: 1 INLET, 3 OUTLETS PROPOSED SEPTIC SYSTEM UPGRADE PLAN USE 3-500 GALLON LEACHING CHAMBERS IN SERIES SURROUNDED BY DOUBLE WASHED STONE ON ALL SIDES 1 071 SHOOTFLYING HILL RD, CENTERVILLE, MA SIDEWALL AREA: 2(12.8' + 25.0') X 2 = 151.2 S.F. Prepared for: ALJ Realty Corp, 128 Main Street, Hyannis, MA 02601 BOTTOM AREA: 12.8' x 25.0' = 320.0 S.F. Engineering by: SCALE DRAWN JOB. NO. TOTAL AREA:..............................................................471.2 S.F. Engineering Works, Inc. N.T.S. P.T.M. 167-19 12 West Crossfield Road, Forestdole, MA 02644 DATE CHECKED SHEET NO. DESIGN FLOW PROVIDED: 0.74 GPD/SF(471.2 SF) = 348.7 GPD (508) 477-5313 5/10/19 P.T.M. 2 of 2