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1225 SHOOTFLYING HILL RD - Health
12-25 Shootflying Hill Rd Centervilfe P i90 113 ® r UPC 12543 i�o. 53LOCi I 1 TOWN OF BARNSTABLE LOCATION 11. 6 S HNWt—rL v 1W Cs H 1 I I &.EWAGE# ZC)U e d S P VILLAGE C�^+eV- /1�� e ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /SDO LEACHING FACILITY:(type) I V J�CH C-S�3;Z. (size) KA3 .I— NO.OF BEDROOMS OWNER ) PERMIT DATE: 11 Lzn 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 • 1 1 r f i y1 1 I � 6 4,= I l zz_' c A ; 1 2-� ire !' ; 2� b3 X ,T S r N � � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS 2ppliLatloii for bisposaf *pBtrm Construction Permit Application for a Permit to Construct( )- Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components - Location Address or Lot No. 1 �,�°�, (LZJ S��Cn ��y� ��'��� Owner's Name,Address,and Tel.No. ��F� ��(�R,� Y C 10Z I z, 1 _ j 21..�SH�1 r-1 q,V Cr H i Y_L► e I�; �`L^c lli�L.i. Cl Assessor s Map/Parce� (��-)\" Installer's Name,Address,and Tel.No. tR IL S-T4e4�S Designer's Name,Address,and Tel.No. Type of Building: w Dwelling No.of Bedrooms Lot Size j Q "'sq.ft. Garbage Grinder( ) ':. Other Type of Building c��� No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided gpd Plan Date Number of sheets Revision Date Title Size of-Septic Tank Type of S.A.S. Description of Soil 7 Nature of Repairs or Alterations(Answer when applicable) _ I�? 1,� 1 c � en-1 ' � + Date last inspected: } Y Agreement: s ('-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 Env' m al Code and not lace the system in operation until a Certificate of Compliance has been issued Py this Board o rr Si ed Date Application Approved by Date 06 Application Disapproved by Date for the following reasons Permit No. o _ Date Issued r 1 , Fe Now Enteredmecomp: THE COMMONWEALTH OF MASSACHUSETTS --f'"_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Ye .. ftplifation for Veposal *pstem (Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. WS Sh 4 'i�t �-1�t( Owner's Name,Address„and Tel.No. Assess Vr s''1�1a'p71ga'rcfti�'� 11 12Z Sr 5}10d Tr 1 y 1 V Cs—H 1 u_ e D,camev,tA,,,� Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. t Type of Building: Dwelling No.of Bedrooms Lot Size A-- sq.ft. Garbage Grinder( ) Other Type of Building Pte— a., c No.of Persons ` �• '" Showers( ) Cafeteria( ) Other Fixtures f. Design Flow(min.required) gpd De'sign-flow provided )gpd Plan Date Number of sheets Revision Date f " ••?`:" Title Size of Septic Tank n0 Type of S.A.S.�, Description of Soil Nature of;Repairs or Alterations(Answer when applicable) !km" 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 Env' ante tal Code and not lace the system in operation until a Certificate of Compliance has been issued by this Board of a tih. , Si .ed Date Application Approved by Date 4 r (� Application Disapproved by Date ` for the following reasons ,'. Permit No. Date'Issued --- ------------------------------------ ---------------------------------------------------------------------------------------- a 0 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned O by t at�'J_Z � �� �elr.- Hill- d-�. §has been constructed in accordance 0 0 �. with the provisions of Title 5 and the for Disposal System Construction Permit N `dated ( . Installer Designer #bedrooms Approved design flow and The issuance of this permit shaynot be construed as a guarantee that the system 1-11q ion ig ed. Date 1 o Inspector 5 , ---------------------------------------------------------------------------------------------------------------- ---------------------- No. �� `�� Fee ,GJC `'' ✓ C THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS disposal 6pstem Construction Permit Permission is hereby granted to Construct(, ) Repair( ) Upgrade( ) Abandon( ) System located at 1Z-25- _SHWT1-MAJ /jL 121), 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:Constructiontmust be ompleted within three years of the date of this perm• Date 1 `/� �� Approved by T®wn of Barnstable w Regulatory Services Richard V. Scali,Interim Director ansxar� s � Public Health Division �t639. A�� Fp� Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 r Installer& Designer Certification Form Date: 161 Sewage Permit# Ze-z.,; 351-5,Assessor's Map\Parcel �V De ' ner: ° '�'� �41S l / Installer: EV:i C,[U -�FL Address: Vol Address: �, �( `11 i - On 11113120 i 'A C <sTCVfAtS was issued a permit to install a (d e) (installer) pp�,,, septic system at '�'� S�i 1��Y IPJ6'tfi Lt, / V based on a design drawn by (address) dated e�nSQ�• r) I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. 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 Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms of the IAA approval letters(if applicable) 4 —4; (Ins e igna re) R `r W (Designer'ss Signature) (Affix ere) EASE RETURN II O B STABLE PUBLIC HEALTH D N. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc I Town of Barnstable Inspectional Services Department BARN AULML MASS. g Public Health Division 1639•'0n►axi" 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7015 1730 0001 4987 9057 October 28, 2020 US BANK NATIONAL ASSOCIATION TR 3000 KELLWA6Y DR STE 150 CARROLLTON, TX 75006 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1225 Shootflying Hill Road, Centerville, MA was inspected on 10/08/2020 by Shawn Mcelroy, 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 is above the 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 T BOARD OF HEALTH lKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Title V Inspection Report Letters Mailing\Failed or Needs Further Evaluation Letters\1225 Shootflying Hill Road Centerville.doc �.t►+rF rqy, Town of Barnstable • snxtvsrnBi.e, MASS. 9. Inspectional Services Department Public Health Division 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 4/26/19 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 11 ❑ 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 ❑ Structurally unsound septic tank or SAS O E 1 YEAR DEADLINE CRITERIA Static liquid level in the distribution box is above the outlet invert due to an overloaded or clogged SAS or cesspool ❑ A portion of the SAS, cesspool, or privy is below the high groundwater elevation ❑ A portion of the cesspool is located within a Zone 1 to a public well ❑ A portion of the cesspool is located 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 Repair deadline: Q:\SEPTIC\DEADLINES TO REPAIR FAILED SYSTEMS.doc Igo- 11.3 %o c Commonwealth of Massachusetts Title 5 Official Inspection Form 'I wa i�l Subsurface Sewage Disposal System Form Not for Voluntary Assessments 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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. A. Inspector Information 51 fr 141S-$ Shawn Mcelroy Name of Inspector Upper Cape Septic Services ' Company Name P.O. Box 73 Company Address East Falmouth MA 02536 City/Town State Zip Code 508-495-0905 S13971 Telephone Number License Number B. Certification I certify that] 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 theproperty 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 10-8-20 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts r� Title 5 Official Inspection Form Iw�' hI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootfl ying Hilt Rd Property Address Bank Owned (Contact David-Holt cLD Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary r 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 "ConditionalPass" 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.712 612 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 c Commonwealth of Massachusetts ; Title 5 Official Inspection Form i�► Subsurface Sewage Disposal System Form -Not for Voluntary Assessments s� fd` 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is r required for every Centerville MA 02632 10-8-20 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑Y ❑ N ❑ ND (Explain below): R ❑ 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 El ❑ ND (Explain below): ❑ obstruction is removed ❑Y ❑N ❑ ND (Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 18 Commonwealth of Massachusetts a �al Title 5 Official Inspection Form w: ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootfl ying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. []The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: ** This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate "Yes"or"No"to each of the following for all inspections: Yes' - No ' ® ❑ 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 i Title 5 Official Inspection Form it Subsurface sewage Disposal System Form -Not for Voluntary Assessments 9 p Y rY e>r 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real-Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 - 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 '/z 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. ® El The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner,should contact the Board of Health to determine what will be necessary to correct,the•failure. 5) Large Systems:To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. _ Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well t5insp.doc•rev.7/26/2018 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts r ,w� Title 5 Official Inspection Form FBI Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootfl y�`�•_,� ? y'ng Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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 aH 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? ® 0 Wasthe 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 QQ Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments - 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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 flowbased on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Description: Number of current residents: 0 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: 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 Yrl Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt Today Real Estate 1=800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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: N%A 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 M Subsurface Sewage Disposal System Form -Not for Voluntary Assessments >" Shootfl In 1225 Hill Rd •Tt % Y 9 Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Aftemative 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: 2011 Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑ cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): Good condition. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 r .., Commonwealth of Massachusetts ii Title 5 Official Inspection Form Sri Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): ' Depth below grade: 12"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gal Sludge depth: 12" Distance from top of sludge to bottom of outlet tee or baffle 20" Scum thickness 211 Distance from top of scum to top of outlet tee or baffle 5" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. t5insp.doc•rev.7/26/2018 Title 5 Official Inspecton Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official, Inspection- Form iil Subsurface Sewage Disposal System Form -Not.for Voluntary Assessments 1225 Shootflying Hill Rd sir_ •T,,;,> Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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 �l Title 5 Official Inspection Form I�i� ibl. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20, 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 2" Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D-box was filled with sludge and scum that had overflowed from the septic tank. t5insp.doc-rev.7/2612018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ai Subsurface Sewage Disposal System,Form -Not for Voluntary Assessments r >' 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt c@ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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: 2x3x65 ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Chi Subsurface Sewage Disposal System Form -Not for Voluntary Assessments' 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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.): Leach trench has signs of overflow into d-box and black staining of the,stone surrounding the field. 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.): i 4 ti• t5ins o v /p.d c rev.7 28l2018 Title 5 Official Inspection Form:Subsurface Sewage System Disposal S tem•Page 14 of 18 P Commonwealth of Massachusetts p Title 5 Official Inspection Form + ` W.n cr i�l Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .� r ,r �r- >` 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City/Town 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 01 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 Y f Commonwealth of Massachusetts �1 Title 5 Official Inspection Form d ill Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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 withini 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 0 l p ge r3 t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 18 � T Commonwealth of Massachusetts ,Pa Title 5 Official Inspection Form it Subsurface Sewage Disposal System Form,-Not for Voluntary Assessments, 1225 Shootflying Hill Rd ` Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 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: 124 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: Original design plans show no groundwater at 12'. 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 c Commonwealth of Massachusetts Title 5 Official Inspection, Form�I �> ;i6I. Subsurface Sewage Disposal System Form -Not for Voluntary Assessments Fa•; >k:' 1225 Shootflying Hill Rd Property Address Bank Owned (Contact David Holt @ Today Real Estate 1-800-966-2448) Owner Owner's Name information is required for every Centerville MA 02632 10-8-20 page. City(fown 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 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed, ® D. System Information: For 8: Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 18 of 18 TOWN OF BARNSTABLE LOCATION���J f , ���i.:,� /�// SEWAGE# 20 VILLAGE Ce r Vlrv/Ile ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE NO. /�..!di i/� 1*2 ✓a+i ,. f�7 02 `I SEPTIC TANK CAPACITY 1 rO U LEACHING FACILITY.(type) �i/''t "' P9 t (size) 1 X 3X e i NO.OF BEDROOMS 3 OWNER /'fi r .O%"e �e F C p e PERMIT DATE: / / 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 �� 67 / � S /s No. C"©l/ �� Fee v THE COMMONWEALTH OF MASSACHUSLTTS Entered in computer: PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MASSACHUSETTS Yes 01pplitatlon for ;Disposal *pstrm Construction permit Application for a Permit to Construct( ) Repair Upgr de( ) Abandon( ) Complete System ❑Individual Components IV Location Address or Lot No. _*Iry i Owner's Name,Address,and Tel.No. / As essor�Ivi'ap/Parce // ✓��i 90 13 M ^rjv.r r; .t o bt 4�1 Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.Ko. C_Ile Type of Building: ''� IF e Dwelling No.of Bedrooms Lot Size 7 D sq.ft. Garbage Grinder( ) Other Type of Building 14e I• No.of Persons' Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required). gpd Design flow provided gpd Plan Date l f 0 Number of sheets Revision Date Title Size of Septic Tank 4�5-0 D Type of S.A.S. p/I-C I e r( OO c Descri hon of Soil /✓ew Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S' tiedDate f � Application Approved by Date Application Disapproved by Date for the following reasons Permit No. I i ��O'� —-- Date Issued ` No. ©.L/ G0� 4 Fee j THF,_C.OMMONWEALTH'6F MASSACHUStTTS 4 Entered it computer: - PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS,, Yes ��•_ "I'application for -isposal 6psteut Construction Permit t Application for a Permit to Construct( ) Repair( Up gr de( ) Abandon( ) Complete System ❑Individual Components Location Address or Lot No. n N Owner's Name,Address,and Tel.No. Assessor's Ma�/Parc�l 4 // �d M/J',/o !C /�41 j// p 9e —/)3r r Installleer''s Name,Address,and Tel.No. Designer's Name,Address,and Tel No. Type of Building: �'/ / {� �" • ot"`� g Dwelling No.of Bedrooms Lot Size / 2 7 0 sq.ft. Garbage Grinder( ) Other Type of Building /'1 e S• No.of Persons 3 Showers( ) Cafeteria( ) Other Fixtures ' Design Flow(min.required) gpd Design flow provided gpd Plan Date / 1 7 /0 Number of sheets .Revision Date Title ;; Size of Septic Tank q4 SO O Type/of S.A.S. Description of Soil /V ew / /B N/L ,� j mot.c.L, w < } ���f `v Nature of Repairs or Alterations(Answer when applicable) Date last inspected: ` Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in i 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 ned / Date Application Approved by / Date t Application Disapproved by Date for the following reasons 1 Permit No. l Cr O Date Issued --------------------------------------------------------------------------------------------=-=---------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired ) Upgraded( ) Abandoned( )by (J at / a f0 o V i �� �„ o/ has been constructed in accordance with the provisions of Title 5 nd thrfo isposal System Construction Permit No. t �a dated I L� Installer Designer C✓ l #bedrooms 3 Approved design flow and The issuance of is permit shall not be construed as a guarantee that the system willlfunch n a as desig1-x� Date Inspector ,f k lf ---------------------------------------------------------------------------------- -------------------------------------- No. �OO�-- Fee DO THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION—BARNSTABLE,MASSACHUSETTS Misposal 6pstem Construction 3permit Permission is hereby granted to Constructs ) R pair(V< Upgrade( ) Abandon( ) System located at f!�6 0 1i 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:Constructio /emus /be completed within three years of the date of this permit. Date / ! Approved b i f Town of Barnstable Regulatory Services Thomas F.Geiler,Director BARNWABMO Public Health Division 39. Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: o G( Sewage Permit# Assessor's Map/Parcel Installer&Designer Certification Form Designer: ka— E.. do-rr►ws ke h,2 S. Installer: r '^ ekr i Address: 9 L eda-. (Zo k- La-+,,e_ Address: yJ I o.� e- ✓� 2 On was issued a permit to install a (date) (installer) ,v i septic system at f U f�io�o7�o A_ 4#//4W C�il�based on a design drawn by (address) (�/-e,K A.�f dated t t&7 Z 0 (designer)( V I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Stripout (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Stripout(if requ ected and the soils were found satisfactory. �,SHOFOLEN Mq , � ��A�;/ ERIC (Installer's Si ' tur r oo HARRINGTO IVo.1070 �F (Designer' Si re - (Affix De p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. gAoffice fonnsldesipew4Mtcation form.doc CJ March 30, 2011 Barnstable County Health & Environment 3195 Main Street Barnstable, MA 02630 Re: 1225 Shoot Flying Hill Road, Centerville, MA To whom it may concern, Since the residents of the above address bought this property in 2005,they have been running an automobile repair business on this land. Although there have been numerous complaints to the Town of Barnstable and the Barnstable Police Department for many infractions, nothing seems to deter these people. The automobile business is nothing less than blatant. It is quite obvious that untold hazardous waste is continually seeping into the ground, not only with the continual automobile repair, but with the stored, unregistered vehicles regularly parked on the property. We call the police department occasionally to order the vehicles removed,when, a few days later,vehicles soon reappear. Yesterday morning, we reported multiple unregistered vehicles on the property. Yesterday afternoon, one of the residents was working on a truck which was on a lift. Vehicles will be removed in a day or two, no doubt; and in a week or two,they will be replaced. With hopes you can protect our neighborhood and, more importantly,the environment. Sincerely, Concerned Neighbors CC: TOB Conservation Division 200 Main Street Hyannis 02601 Y' Y,�. .� f `:/ .�� w. i .+- -. .,. ... .... - � � .. /�. II F _� _� �� , .. ; _ �� �_ - , .y Si S # i� 4l {ii �ii 1 it li �1 {� ��li t441f t l 1 �„ �. ;, r t � p�. ,a:yyy?4 f Town of Barnstable P# L3z Department of Regulatory Services MAES. Public Health Division Date f 0 200 Main Street,Hyannis MA 02601 Date Scheduled_ Y�`//fl Timer UJ r--�1=.L� Fee Pd.,_ c f �_.,. . ,. .'Foil Sutabili } "' m ty Assessent for ,Sew gerhposal,Performed By: 44 iF.v.-, 4/r92Qfy�ro,� R S Witnessed B G - �� Location Address LOCATION GENERAL INFORMATION ,r J / 12-7 S dj O o /y f���/ wner's Name 114 17 o Assessor's Map/Parcel: J<tisk• e r- Y-e, ✓7��e i?j,�i Address 0 j 6l l �0 i !_13 1 Engineer's Name NEW CONSTRUCTION • «� 1 A- e REPAIR Telephone# S � D r j°2 E�- =4 7 0,PrlD6.t.T/� c. 1 Land Us ' p �r •"� t v Slopes(%) 0-.? . (.,Surface Stones_ ' ivO✓ :1 ,- d'�� s Distance from pc P SQL s r� Open n Water Bodyft. ossible,Wet Area ti y , ��_ft•.;Drinking,Water Well Drainage Way ft Property Line IO r•7' ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands to proximity to holes) �1 D K 28 4d g �, D 140.6s iisit o N v to V. 11 RF 0 K N a Y/n,.. P - p Parent material(geologic) Depth to Bedrock ' Depth to Groundwater. Standing Water in Hole: 4io a Q Weeping from Pit Face yf 1kA_ A r Estimated Seasonal High Groundwater 6u2CO r-1 - u DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: /0,-1-1E in, Depth to weeping from side of obs.hole: in, Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor- Adj,Groundwater level Observation PERCOLATION TEST Date� . Thne �' / . Hole# 1 Time at 9" Depth of Pere r.q P7 Time at 6" Start Pre-soak Time @ lima(911•6") End Pre-soak Z !j•'30 Rate Min/Inch �' Z Site Suitability Assessment: Site Passed Vo"'_ Site Failed: Additional Testing Needed(Y/N) ` 1 Original: Public Health Division Observation Hole Data To Be Completed on Back----------- �_ ,,r ***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:\SEPTICVERCFORM.DOC DEEP-OBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture .Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. i tenry,%Graven 0—-7 4.1 /o '7 ( -32. w 32-6 c 1 SR..,d . -Z.S-r y -moo 7o-ts'9'o G7- DEEP Cd a•rfc Ste.. � .w OBSERVATION HOLE LOG Hole# 7— Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Moulin g (Structure,Stones,Boulders. rnnziqenCy.% ravel 4 LS loY,� 3z AID _ 3offw IL `nr2 do C. .h-C Sa=i`d" 2•S'yIC aio', „ z�:' s„h -�., 01 60-tl;YY t, z �da�1zJ c/ 2•S G(e.e.%, 'ro9•�e.•,-J DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Co i to e DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Sall Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders. Consistency, 1 Flood Insurance_Rate Man. _ Above 500 year flood boundary No_ Yes Within 500 year boundary No= Yeses Within 100 year flood boundary No, Yes Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas obsbrved throughout the area proposed for the soil-absorption system? Y •S If not,what is the depth of naturally occurring pervious material? Certification I certify that on S'1 r (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 tr g, perfise and perience described in 310 CMR 15.017. Signatur. Date /L L1D Q:\.SEPTICIPERCFORM.DOC IL W/7 ed 0!4?0L CC-CC eaL i y 11007011"%(� �iQsr r�J�'e 6p NUAPAe rOU-Y -,,,1 i'y /'n ern hcfl-T clot 0 ers o/so /"fSlole- ire o c ash j l:l y4f�> ��'� Gtn y 6/fry Qr�jrle� s' G�noL eir y(f a45- y 9 y� ec ha n �cs hop �a`n e r � army e- c�h�c�, fit!rO&I' y of I;' Ugh 1 Cle-s �or /�c j J Y LUa rK z 0 7-06 �s � spa /l nor boo IQ��P I-h(f I/*I/,- fey coo The- Gvorj-� a 11� ellse /L� the pollvz�/;!5�e7 o/' ae 6011 (�4Ll(ll' U,(7d prO/n Sp%//�/)� a/l� ���- the rO 9 �i rYi cvi/7�' o 7osi01 e- �/'/U�(-�/cz l.�/1a�9�'GU/.tz� �f� �`CL-ram/' //� �elC' ��i��//�s /� y it 0-// cOeS dd6ul? 7hcrzf 1,-5- oCrair/ p�jrec y v �i/� �5�►o lle/"rU®1' ,crass �e ��e�� and fey /he�� Seems, ,� �Oa,4-Pd S0 i/ 0-1?oC �/�rOlUi/19 /f�L/O /s0 ��ere ClUeS go � om Mere 2 TAa-� Yard S -To X IC WASTE DO Mp avy� U ery C 0 nCernec{ . So a-(-(f 6�e 11-7afi�y/ p-� y 117 d�Wl �r'o /�c� � � a� ►/S�G(lar.�i/� s, 0 This pa/lo -iow o1 61�e yravvW a-,d �-hc uae- 6 V er l aaKPc� y/nor e -Th J�s J� Aal�V&7ip9 C�n�i���s h a� s/NIne o-11 o cve oL �-o Co,,-) �-i n vif Doc-3 n v oo e ca-rc canf.. i Wh--c this i n the hopes �V e n U c� I lac 9 e o Ca f sec- ok e a c--� m e Q.nct, of Jh c- �o o pe r �t v ho r i i es our USA 0-nc� pI(fa-Sc ola yeur sab, i�� S+ +mp1e. -Kn�, use ta-re Cal. Ocr i UC, ba a-flO - ce GL (00 K . COPieS �c : � Pnn--reI `� i 1 ANCHOR AUTO BODY IS GOING GREEN WHAT DOES THAT MEAN? The newest innovation in our industry is water borne paint systems. The use of water borne paints eliminates VOC contaminants. This is better for our environment and our employees. We are currently participating in a program with the Cape Cod Tech culminating in the full implementation of a water borne paint system. We look forward to being one of the first collision repairers on the Cape to implement such a system. Since waterborne paints use water as a mixing agent, not harmful chemicals, we will also be minimizing the production of hazardous waste. o We have installed a new spray gun cleaning system which uses recyclable cleaning agents that greatly reduces the need to store and remove hazardous waste. The new HVLP (High Volume Low Pressure) spray guns put most of the sprayable material on the vehicle and not in the atmosphere. All spray guns are approved by the Commonwealth of MA Department of Environmental Protection. o We have installed an air filtration system in our shop to capture any airborne dust. Our employees are all supplied with personal respirators and our painters are utilizing fresh air masks and hoods. o We have implemented a steel recycling program with a local firm o All plastic bumpers that have been replaced are returned to a supplier for recycling o Replaced aluminum parts are returned to a supplier for recycling i nchor Auto Body has always been on the cutting edge of technology. We're oud to use the latest technology to do our part to preserve the environment, protect our employees, and make a difference. r'•' At a SAN108 Date: TOWN OF BARNSTABLE / TOXIC AND HAZARDOUS MATERIALS ON-SITE INVENTORY NAME OF BUSINESS: 15Nc• BUSINESS LOCATION: -?'-3 612PG A—no P AJIS INVENTORY MAILING ADDRESS: 4S TOTAL AMOUNT: TELEPHONE NUMBER: CONTACT PERSON: EMERGENCY CONTACT TELEPHONE NUMBER: MSDS ON SITE? TYPE OF BUSINESS: AUTV + ©�'� ���-//Z #-S, 3ur `&ZZ5 INFORMATION/RECOMMENDATIONS: Pk/wn ����� �s �4'�� , � Fire District: fD12Zr11 IW' 7W P,"7- 9i.VR.'*'HSbS TO 6 e V PbIATE; AA/,VIS *L�O�IJT)�%�nt✓�xN T[_1�V-TO 7-4 705TEb : CnA)TA--T V Flo IJG Q QJ ILLQ-5WS f::&K r I WA-SM 14*1LLeY2-5 . D ED ky NVv rZ._A1 Af6C-4-tUrL R ICK R-0c 4 '06, ,LA 667— AYA Z_;R, vS if/ I b ' 9w-/133 WA Sri"-14K-&rA a ` SAAgee- 41' PA-IAJT 1) ACS 2 Waste T :jYA b /.Z/�z o s Last shipment of hazardous waste: Name of Hauler:AvrP,43vav nation: & /3o�Zs. Waste Product: k114-srZF-P 11JT 46,1762 icensed? es No NOTE: Under the provisions of Ch. 111, Section 31, of the General Laws of MA, hazardous materials use, storage and disposal of 111 gallons or more a month requires a license from the Public Health Division. LIST OF TOXIC AND HAZARDOUS MATERIALS The Board of Health and the Public Health Division have determined that the following products exhibit toxic or hazardous characteristics and must be registered regardless of volume. (P-6 N°-0 W I m ?Hit" / Observed/Maximum Observed/Maximum woRD5 ' W*SrE PAI)J a Antifreeze (for gasoline or coolant systems) _ Misc. Corrosive 'A 14AZAi2DavS ��sf NEW USED Cesspool clean�rs r>��KA�t Automatic transmission fluid Disinfectants -k obaltj SPILL SKIT t T-U O VJ 11n+ *15'56 vim' Engine and radiator flushes Road Salts (Halite) tVool-s, PA-D S) ItAj 014 Hydraulic fluid (including brake fluid Refrigerants N o"� iTS �oua rlatis Y ( 9 ) 9 cokA n iJ6.���'( VQ /� • Motor Oils Pesticides -Ie 1=I e cxT i U&vts S NEW USED (insecticides, herbicides, rodenticides)k+2t up Gasoline, Jet fuel, Aviation gas Photochemicals (Fixers) TV bA`rC- Diesel Fuel, kerosene, #2 heating oil NEW USED b-1E WASP 571�-T7 oar tS Misc. petroleum products: grease, Photochemicals (Developer) �lJ 0s_> LS lubricants, gear oil NEW USED Degreasers for engines and metal Printing ink Degreasers for driveways & garages Wood preservatives (creosote) Caulk/Grout Swimming pool chlorine �j. e -V/ Battery acid (electrolyte)/Batteries Lye or caustic soda Rustproofers Misc. Combustible ,,,�_ � Car wash detergents Leather dyes . Car waxes and polishes Fertilizers L Asphalt & roofing tar PCB's Cfx?P_co,-TS �EA�C[�ZS, iNAI Paints, Other chlorinated hydrocarbons, Lacquer thinners (inc. carbon tetrachloride) NEW USED — Any other products with "poison" labels Paint &varnish removers, deglossers (including chloroform, formaldehyde, Misc. Flammables hydrochloric acid, other acids) Floor& furniture strippers Other products not listed which you feel Metal polishes may be toxic or hazardous (please list): Laundry soil & stain removers �) SSGAl-4-eJ �N "S D1CVJAS (including bleach) 0,+/A) &ArMA-L Spot removers &cleaning fluids -Z-) i I—OtU04) 5 0,+IAJT G,vA) (dry cleaners) Other cleaning solvents Fpw_UP _ G L & K Bug and tar removers /NSp&ZhaAJ UJILL Bt Windshield wash /,&7e v zM&� /N �oua-r� s/x INES WHITE COPY-HEALTH DEPARTMENT/CANARY COPY- COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION OJAP i.OT TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 1225 Shootflying Hill Road Centerville MA 02632 Owner's Name: John Dean Owner's Address: 7 Corser Street RECEIVED Holyoke MA 10140 Date of Inspection: August 12,2004 SEP 16 2004 Name of Inspector: PATRICK M. O'CONNELL Company Name: SEPTIC INSPECTION SERVICES CO. TOWN OF T HEALTHH D DEPEPT. . Mailing Address: 189 CAMMETT ROAD MARSTONS MILLS MA 02648 Telephone Number: 508-428-1779 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on010F training and experience in the proper function and maintenance of on site sewage disposal systems. I a approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system:;��� �•.•••• Ss, iZ _X_ Passes pA ••ycGn Conditionally Passes = ; •m Needs Further Evaluation by the Local Approving Authority Fails y • Inspector's Signature. ,_____..- aL,� Date: _8/12 S/04_ ���i��FINSPE� The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. Notes and Comments: Cesspool with 4-5"standing water and an empty overflow pit. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 ' Page 2 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: _XX_ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: T41P r, T--t;nn Y7-4/1;iinnn 2 Page 3 of I 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(l)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier, if any)determines that the system is functioning in a manner that protects the public health,safety and environment: _ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: Titles G inenartinn Anrm Ail ci,)nnn 3 Page 4 of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No _X_ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool —X— Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool —X— Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool _X_ Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow _X_ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped _X_ Any portion of the SAS,cesspool or privy is below high ground water elevation. _X— Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _X Any portion of a cesspool or privy is within a Zone 1 of a public well. _X_ Any portion of a cesspool or privy is within 50 feet of a private water supply well. _X_ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] _No_(Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. Title C T"e—t;^" V^—4/1 C/7AAO 4 Page 5 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No _X_ _ Pumping information was provided by the owner,occupant,or Board of Health _X_ Were any of the system components pumped out in the previous two weeks? _X_ Has the system received normal flows in the previous two week period ? _ _X_ Have large volumes of water been introduced to the system recently or as part of this inspection? _ _X_ Were as built plans of the system obtained and examined?(If they were not available note as N/A) _X_ _ Was the facility or dwelling inspected for signs of sewage back up? _X_ _ Was the site inspected for signs of break out? _X_ _ Were all system components,excluding the SAS, located on site? _X_ _ Were the septic tank manholes uncovered,opened,and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum? _X _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: Yes no _ _X_ Existing information. For example,a plan at the Board of Health. _X_ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] Title G inenortinn Rnr !/I r,nnnn 5 I 'Page 6 of I 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms):330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use:(yes or no): No Water meter readings,if available(last 2 years usage(gpd)): 2002—25,000 gal.2003—13,000 gal=52 gpd. Sump pump(yes or no): No Last date of occupancy: Occupied day of inspection,has intermittent year round use COMMERCIALANDUSTRIA L Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no): Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records: None Source of information: - Was system pumped as part of the inspection(yes or no): No If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM _Septic tank,distribution box,soil absorption system _Single cesspool —X_Overflow cesspool Privy _Shared system(yes or no)(if yes,attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight tank _Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: unknown Were sewage odors detected when arriving at the site(yes or no): No Titles G Tncnurtinn r.' A/ cnnnn 6 Page 7 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 BUILDING SEWER: X (locate on site plan) Depth below grade: 1' Materials of construction:_X_cast iron _40 PVC_other(explain): Distance from private water supply well or suction line: 30' Comments(on condition of joints, venting,evidence of leakage,etc.): SEPTIC TANK: No (locate on site plan) Depth below grade: - Material of construction: concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no):_(attach a copy of certificate) Dimensions:- 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: STICK WITH HINGE FLAP. Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): GREASE TRAP: No (locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): Titla i inenartinn Pn 7 'Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 TIGHT or HOLDING TANK: No (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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: No (if present must be opened) (locate on site plan) Depth of liquid level above outlet invert: - Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box,etc.): PUMP CHAMBER: No (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): Titlo G Tncnartinn T7nrm 4/1 Vnnnn 8 Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 SOIL ABSORPTION SYSTEM(SAS): X (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: _X_overflow cesspool,number: One 6x6 block pit. innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation, etc.): Blocks are intact and structurally sound.Pit may have been half full at one time but not in recent years. CESSPOOLS: X (cesspool must be pumped as part of inspection) (locate on site plan) Number and configuration: One with overflow Depth—top of liquid to inlet invert: 5' Depth of solids layer: 1" Depth of scum layer: 0" Dimensions of cesspool: 6x6 Materials of construction: Block Indication of groundwater inflow(yes or no): No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.): Observed 4-5"water in cesspool.Blocks are structurally sound. PRIVY: No (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.): Title 1�Tnonortinn 17nrm All 19110nn 9 • Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1225 Shoot Flying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Shootflying Hill Road Act \2ZS' k9 t� 20 Cesspool with overflow Titles C T"—art;— T7nr Ail nno 10 Page I 1 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 1225 Shootflying Hill Road,Centerville Owner: John Dean Date of Inspection: August 12,2004 SITE EXAM Slope None Surface water None Check cellar Dry Shallow wells None Estimated depth to ground water: More than 25 feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) Checked with local Board of Health-explain: Checked with local excavators, installers-(attach documentation) _X_Accessed USGS database-explain: USGS topo map and town GIS. You must describe how you established the high ground water elevation: Town groundwater contour map shows water at el.30 and topo map shows property above el.60. 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Signature ` ■ Complete items 1,2,and 3. I - R may( ■ Print your name and address on the reverse X ❑Agent _ 1 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 or on the front if space permits. 1:_Article Addressed_to:__� _ __� n-_IsdAm:on+address different from item 1? ❑Yes i delivery address below: ❑ No I 1 � I r US NATIONAL ASSOCIATION TR I KELLWA6Y DR STE 150 `. eARROLLTON,TX 75006 I _ I I _ , _ �r ❑Prior' Mail Expresso IIIIIIII IIII IIIIIIIIIIIII IIIIIiIIIIIIII IIII ❑AdultSignature ❑Re stere dMallR ❑ dull Signature Restricted Delivery ❑ �istered Mail Restricted) I Certified Mail@) elrvery Certified Mail Restricted Delivery Return Receipt for I 9590 9402 5849 0038 3915 18 Merchandise ❑Collect on Delivery \` ❑Collect on Delivery Restricted Delivery ❑Signature ConfirmationT" I \\\ o�netict-a7'Nrti-imber_C1730 Transfer_from service IabeQ _9057_ •tail ❑Signature Confirmation I r u 1 3 1 7 3 0 0001 4987 fail Restricted Delivery Restricted Delivery I PS Form 3811,July 2015 PSN 7530-02-000 9053 Domestic Return Receipt «r Town of Barnstable Inspectional Services Department r r a + "MASS. Public Health Division 9 MASS. A}F1659. A 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL47015 1730 0001 4987 9057 October 28, 2020 US BANK NATIONAL ASSOCIATION TR 3000 KELLWA6Y DR STE 150 CARROLLTON, TX 75006 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 1225 Shootflying Hill Road, Centerville,MA was inspected on 10/08/2020 by Shawn Mcelroy, 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 is above the 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 T BOARD OF HEALTH 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\1225 Shootflying Hill Road Centerville.doc 3'-0- 2"-1/8"-1/2" GENERAL NOTES N Double- Washed Stone 1. ADDRESS: #1225 SHOOTFLYING HILL ROAD, CENTERVILLE EVS77NG MIX EL€V-s8.s fthe fabric , " 2. ASSESSOR NUMBER: MAP 190 PARCEL 113 PROPOSED SAS 4 perforated SCH 40 P.V.0 3. DEVELOPER'S LOT: LOT 5 slope-0.005'/ft. ;, 4. TOPOGRAPHIC INFORMATION WAS COMPILED FROM AN ON THE o >tp �, Provide l 65 L x 3 W x 2 D leach. trench GROUND INSTRUMENT SURVEY. its & O with 4" dia. perforated SCH 40 PVC °provide end caps at 5. TOWN WATER IS PROVIDED TO THE SITE & SURROUNDING PROPERTIES• p downstream end (typ.) _ 0 o� > y��h and an observation port. 3/8"-5/8" dia. holes 7. REFERENCE PLAN: LAND CO6. UTILITIES LOCATED PER URT PLAN 32872AWATER DISTRICT ,9c�� Great M J located at $ do 7 o clock. r7 O jd7 l (typical) Design Calculations 3/4"-11 Double-Washed Stone Number of Bedrooms: 3 Existing o 01 �F #1/99 Garbage Disposal: Not allowed with this design. SIT C opo Syoo, LEACHING TRENCH C R 0 S S-SECTION Septic Tank Capacity Required: 330 Gal./Day x 200% = 660 gals. I C '70 8.19' Z h � Septic Tank Capacity Provided: 1,500 gal. H-10 (min. per Title V) 196. /NC y/C( NOT TO SCALE Leaching Capacity i'2equired: 330 Gal./Day tow g? RO Application Rate for <2 min./inch = 0.74 gal/sq. ft. d voter q0 Proposed Leaching Structure: 1-65' x 3' x 2' Leaching Trench Bottom Leaching Area Provided = 195 sq.ft. ' 3-20" DIAM. ACCESS MANHOLES Side Leaching Area Provided = 272 sq. ft. b Total Leaching Area Provided = 467 sq. ft. x 0.74 gpd/sq.ft=345 gpd. ROUTE 2 s 94.9, 98 11' Leaching Capacity Provided =345 gpd. > 330 gpd. required. 10 e" 10 O /c se H. 98.74' v:;• s • x ••'' .� •.:..., ..,.,,..,�: LOCUS 4 4.1 NO SCALE Location' of cesspools per P h�or f ? i' THE ACCESS COVERS FOR THE SEPTIC TANK, s ptic inspection on file 0iBOH ce h ` INLET - OUTLET DISTRIBUTION BOX AND LEACHING COMPONENT68' X oSHALL BE WITHIN 6" OF FINISHED GRADE. CONSTRUCTION NOTES 97.72' /D 'w INSTALL TUF-TITS GAS BAFFLES OR EQUAL ON ALL OUTLET TEE ENDS 1. Contractor is responsible for Digsafe notification 98.59' # ' • N,h.., ,; .,,, � SEALED and protection of all underground utilities and pipes. Q 97,96 SEPT IC TANK ATER-11GHTN SS 2. The septic„tank and distribution 'box shall be set Q STEEL REINFORCED PRECAST CONCRETE 0 SSU E TE E �2 J �• M . 7.93' level an 6 of 3/4 -11/2 stone. PLAN VIEW 3. Backfill should�� be clean sand or gravel with no w L stones over 3 in size. C9 N N �� F � l3-20" REMOVABLE COVERS 3 w© ,� ! ` 4. This system is subject to inspection during installation a to Glen E. Harrington, R.S. 4 rn C a� O o •`• • ��" _' 4 5. The contractor shall install this system in accordance X 98.15 3,min. clearance 3 a .•. Z. • INLET•r with Title V of the Massachusetts Environmental Code. O rC' C] �• Ql INLET 8"mk. 8" min,, 2" min. inlet,to outlet ^'? a ounEr 6. If, during installation the contractor encounters any +.• soil conditions or site Conditions that are different O ,*, +� Qs i �� qu lever `� / 97.74' �/ 10• min r 97.94' �/ ? � , ssl I,, i r _ " from those shown on the soil log or in our design 98 48 I i 1 a=$ 4 o mr"• the installer shall halt installation and immediately notify A v ` Liquid depth a V on aeel• erhead eke Glen E. Harrington, R.S. � c 7. No vehicle or heavy machinery shall drive over the ,L° -77 .L :•'t � ." •' ..•�"r: •''• •' septic system unless noted as H-20 septic components. lo'-O" b o •� 8. Provide 45 mil rubber membrane, as shown on site plan and profile. o� ao ..... T END-SECTION 9. All piping shall be SCH 40 PVC. a ,,ed CROSS-SECTION p'p' g dr,�e 97.63' „ ,, 10. No wells are located within 150' of proposed SAS. woy `J MONOLITHIC 1500 GALLON H-10 SEPTIC TANK 1 t. This design plan shall be used for the septic installation only. ; , .. � NOT TO SCALE 12. install observation port i11 SAS as sho,vn. ,:. 9 j, 13. Provide Wi in Precast products, or equal: 1 , 1,500-gallon seated, LOT 5 '`' 0 monolithic-type septic tank and 1 H 20 DB-3 distribution box. AREA= 10,270 sq. ft. 0 Cr . k�, dv r tl I AJ.// 97.43 6.82' , ' ' SOIL EVALUATION c1Ul a1 �, J f OI f36UTIO PBOX FROM AU Tiii r.•, el / �7 it :xs r��ux��ua sux seams., BE SET LEVEL.FOR AT LEAST 2 FT. 12" fCNC22tTF ctivztz DATE of SOIL EVALUATION: n E. HER 16, 2010 " LOCAL UPGRADE APPROVAL VARIANCE REQUESTED: . Evaluation Performed,By. Glen E. Harrington, R.S. � ••.,�' :.: bs: � w 5• pU1T.ET .,,.,,,,.:.,;•j,•,r Excavator: ARTHUR JOIA,A. JOIA, INC. •1 t• ••••• p g g p K�1�s caul t<° 310 CMR 403(1)(b), A VARIANCE IS REQUESTED TO ALLOW THE PROPOSED SAS 59.01 96.63 Percolation Rate:< 2 m 1 assumed, 24 gals applied during resook ry Witness: David W. Stanton, R.5., BOH Agent G�f p yg,g« ;LET �.` I I 12" INLET TO BE INSTALLED 12 FEET FROM A CELLAR WALL iN LIEU OF THE REQUIRED t� { MIN. 20 FEET OF PROTECTION. A 45 MIL LINER SHALL BE PROVIDED AS MITIGATION. d Test Hole Test Hole ''ll . ..z { {e. s"„,• I 94 b� No. 1 No. 2 l t" (t (u✓I t f #3 she c . , , ` :.b::.•': {� :•x F 2 LOCAL UPGRADE APPROVAL VARIANCE REQUESTED: D S. , SOILS MEV. EP SO" ELEv. }..bh c k dvt) •.�•-�-1&5 . : / 740E 96.93 97 39' 0 09' 0 29.10' r� 310 CMR 4050)(b): A VARIANCE IS REQUESTED TO ALLOW THE SEPTIC TANK 901. Ro tt� // CLAN SECTION CROP, .SECTION to 793 10 o4my•an oemyA•an ��"`P jj c`6`f vjxU �l ......................... _.......... _.....,..,................... TO .BE INSTALLED 5 FEET FROM A CELLAR WALL IN LIEU OF THE REQUIRED wh wot 7• +opt3/2 " IM3/2 C Cw v�Uy"�,iUv r� _ -•••'° �" I MI •M10 FEET OF PROTECTION. A SEALED MONOLITHIC-TYPE TANK SHALL BE PROVIDED er k i��lK ,3 ....H, .:..:.E.......H •t.0..,.....DI,ST•RiBUTI. N........ X y yy p, .. ...... ...... . ...... .... .. 3r lO'A5 5.4r 30• 10YR5 '� 28.12' jN\¢VI / t 4 cN(i' NOT TO SCALE SITE PLAN 14611 n,&r. PERK TEST #13150 or Ye 4 92.51' so- SYe 4 18.95' DEPTH: 69-87" eg• BEGIN SOAK: 12:09 pm �� PERK END SOAK: 12.17:30 pm SCALE: 1 = 20 874111111 •end° �° TIME: 8:30 MIN.- UNABLE TO SOAK 132" 2.SY7 4 7.D9' t44-1 2.5Y7 4 8.12' USE t2 MPI FOR DESIGN PURPOSES No Observed Ground Water f B.M. = 100.00 (Assumed) Soil Evaluation Certification PROPOSED SEPTIC SYSTEM REPAIR I certify that on October, 1995 1 have passed the soil evaluator ON CORNER OF FRONT STOOP examination approved by the DEP and that the nalysis was performed by PREPARED FOR me consistent with the required trainin pe e a experience described A. J 0 IA INC. in 310 CMR 15.017. AT GLEN E. HARRIN ON, P.S. 1225 SHOOTFLYING HILL ROAD SYSTEM PROFILE (CENTERVILLE) BARNSTABLE Existing Dwelling Not to Scale Top of Fndn =99.85' 3 HOLE H-20 a �LEGENDrox(m a location OWNER: MARJORIE F. KASKI DIST. BOX ' Exlstin Grade =98.5t Finished grade over system=2% slope away Ex►stin Grade 98.5 f }} CELLAR gas°iine WALL Septic tank covers must be D-Box over shall be Provide 4"' dia. observation port Min. 2" of 1/8"-1/2" Double-Washed Stone w Approxi at tocattan. 'tot FMq PREPARED BY: • S = within 6 of finished rode within 6 of finished grade to within 3"' of grade or geo-tex a filter cloth wo er I ne , 02 Glen E. Harrin on R.S. S=.01 , T of P n t v= t -te- Existing contour Level for 2 S=0.01 ft/ft g g :. line 1= 15' PROPOSED 3G' a a new 1,500 H-10 I -, 9 Ledo Rose Lane 1,500 GAL. 2 septc tank Marstons Mills, MA 02648 SEPTIC TANK P=95.58' 24" 1 4 ft. cP existing cesspool 70 Inv. #1 elev.=97,18' H-10 _ 0 g P p Tel: 508-428-3862 Install Gas gaf a FacilityElev.=93.40' (to be pumped & removed) F or a ual 65FT. TOTAL LENGTH (32 FT FROM D=-BOX) GISZ�F'` Fax: 508-428-3862 P=96.30 P=95.75' =95.5 ' 3 4"-1'h" Double-Washed Stone E Elev.=91.9 a,p• Observation Port 'q/t// R\P' / 5 Min.(7 t provided) 6" OF 3/4"-11/2" STONE "=20' DRAWN BY: GEH DATE: Dec. 27, 2010 6" OF 3/4"-11/2" STONE LEACHING TRENCH 1 Hole ev.a .23' DATUM: Approx. NGVD FILE: JoiaKaski SHEET 1 OF 1