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Home My WebLink About0029 LONGVIEW DRIVE - Health 29,LohgVief�{Wr:D h` QG�TCi�;iTIC A 252 076 a 0 a o I i �i U o u e n 4 qq TOWN OF BARNSTABLE LOCATION o� e�G�i�� ,,�� SEWAGE# �� VILLAGE Zj ASSESSOR'S MAP.&PARCELcP rod o y 6 INSTALLER' APbIE&PHONEO. - SEPTIC TANK CAPACITY ®� ��• LEACHING FACILITY: (size) 13 �Cd7SXoT NO.OF BEDROOMS OWNER PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: '01W.0 bArW-,z Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility /3a Feet Private Water Supply Well and Leaching Facility(If any wells exist orr " 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 W w � No S� o o '� 0 � WW� � No. d Fee Vv THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I J D PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes / plitation for Disposal 6pstem Construction Permit Application for a Permit to Construct( Repair( ) Upgrade( ) Abandon( ) Xomplete System ❑Individual Components Location Address or Lot Noa9 e1w Owner's Name,Address,and Tel.No. Assessor's Map/Parcel Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.Now 1�� 2e�'pE`�/� �'� s' a'of �i4 �'�'O ��il✓ 6 7 /d Type of Building: Dwelling No.of Bedrooms -� Lot Size sq.ft. Garbage Grinder( ) Other Type of Building ��'f- No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided �� gpd Plan Date Number of sheets I Revision Date Title Size of Septic Tank/�C� �So G�1 T.r��' ype of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Boareof ealth. Si a Date Application Approved by A.. Date �' - 7c) - J Application Disapproved by Date for the following reasons Permit No. )-0 (3 3-!4 Date Issued 0� No. C� (2 Fee --7 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC,HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal,*pstem Construction Permit hs , V. Application for a Permit to Construct(All Repair( ) Upgrade( ) Abandon( ) Xomplete;System ❑Individual Components Location Address or Lot Nog Owner's Name,Address,and Tel.No. _ Assessor's Map/Parcel m2 — o jd' Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. o) o, Q�/4 v�'p ,Q�/-1 .,fX' Type of Building: f - Dwelling No.of Bedrooms 3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building Of'e-P. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3�e� gpd Design flow provided 5 gpd Plan Date g-- —J Number of sheets / Revision Date Title Size of Septic Tank/t/`Gtw /Sov G.�1. � "'!r4ype of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in • V, 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 ealth. r Si Date P,,T! Application Approved by Date 9 - �� Application Disapproved by Date for the following reasons ` Permit No: )_o (3 _.2 X Date Issued 9 - 7u - 13 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 ele4si®e4""C C-erA—Fl,- h s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. Z J( ated -r _70 t 3 Installer r'dPAVr/c' PyC_Designer 464,0 .&� .4r V o- #bedrooms J� Approved design flow gpd v The issuance of this permit all of be construed as a guarantee that the system it Zn ion as designed Date Inspector No. f/ _. Fee 100 (� THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION -BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Permit f Permission is hereby granted to Construct( 41011 Repair( Upgrade( ) Abandon( ) System located at ®/+� 6�G/.cr'Lt. ex - t 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 must a completed within three years of the date of this permirA Date Approved by OCT/02/2013/WED 11 :51 AM 'FAX No, P. 001 Town of Barnstable Regulatory Services Thomas F.Geller,Director ELMMSrnr::e. = MASS, $ Public Health Division pr o,6 Thomas McKean,Director 2.00 Plain.Street, Hyannis,MA 02601 Office: 508-86 -4 44 @@ Fax; 508-790-6304 Date: 6� �' 1 Sewage Permi&:�Q�-l-37c3a Assessor's Map/Parcel Installer &Designer Certification Form �^ Designer: �vX2 Installer: Address., [ '1/�' G G 'f Address: ILW On was issued a permit to install a (date) ` `�( taller) septic system at � P�-4(�� W. 6 lZased on a design drawn by Np (address) , dated "9`.� f'`__1 J (designer) 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'l0' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State& Local '^tions. Plan revision or certified as-built by designer to follow. Stripout(if rP ,�,...�„ acted and the soils Were found satisfactory. D DAV;DB. (Installer's Signature) MASON yr IST � t -e3es er 5 Signature) PLEASE RETURN TO BARNSTABLE PUBL.L- J 1 E OP COMPLIANCE WILL NOT BE ISSUED UN t is, Hsu x ri i tiia 1,'QPUY1 AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION, THANK YOU. 0oFFce fonnsldesienarcerti6eQtion fonn,doc 'i of YKE rGy Town of Barnstable Barnstable Regulatory Services Department ��" BARH,SfAELE. ' p 1 �► 9 9: Public Health Division 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2851 0749 September 30, 2013 Frank J. Ciliberto 29 Longview Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 29 Longview Drive, Centerville, MA was inspected on 7/28/2013,by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system needed further evaluation under the guidelines of 1995 TITLE V,(310 CMR 15.00) due to the following: • Liquid depth in both cesspools is less than 6" below invert. There is less than half(1/2) day's flow. You are ordered to repair/replace the septic system within sixty (60) days 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 Tho as McKean, R.S., CHO • Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\29 Long-view Dr Cent Sept 26,2013.doc Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Lent.." Ma : 02632 7//28/13 page. Citylrown I 7 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. General Information .. on the computer, use only the tab 1. Inspector: key to move your B O cursor-do not Michael DiBuono use the return Name of Inspector key. Cape Cod Title Five Company Name Company Address 6 keefe crt ma 02632 City/Town State Zip-Code Centerville Si13522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information-reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on,my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: Passes ❑ Conditionally Passes [ .� a— i{s7 ❑ Needs Further Evaluation by the Local Approving Authority 7/17/13 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 is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurfa a Disposal System•Page 1 of 17 J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is Centerville Ma 02632 7//28/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: This system contains two cesspools both of wich are in Failure. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form=Not for Voluntary Assessments M 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is Centerville Ma 02632 7//28/13 required for every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ Z Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool , ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code 1 Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool,or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.,[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply El ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. t5ins•3113 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ,M 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual). 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The system is in need of Replacement Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage 28,000 2011 And 9 ( Y 9 (gPd)) 27,000 2012 Detail App 76 GPD , Sump pump? ❑ Yes ❑ No Last date of occupancy: Date Commercial/lndustrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Currently Occupied Date Other(describe below): 'General Information Pumping Records: Source of information: Home owner Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ❑ Septic tank, distribution box, soil absorption system ® Single cesspool ® Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 55 years Were sewage odors detected when arriving at the site? ❑ 'Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"feet Material of construction: ❑ cast iron ❑40 PVC Orangeburg ®other(explain): Distance from private water supply well or suction line: NA feet Comments(on condition of joints, venting,evidence of leakage, etc.): Septic Tank(locate on site plan): Depth below grade: 2ft feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ® other(explain) CID If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 8x5 Sludge depth: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owners Name information is required for every Centerville Ma 02632 7//28/13 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle s .,s 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 "Sludge stick How were dimensions determined? Tape Measure 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(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is Centerville Ma 02632 7//28/13 required for every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 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(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System(SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is Centerville Ma 02632 71/28/13 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: leaching galleries number: El leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1. ❑ 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.): Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 f Ir Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name 02632 7/16/13 information is Centerville Ma required for every City/Town State Zip Code Date of Inspection page. D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately XtC / e�3 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29 Longview dr Property Address C Frank ii a Ilberto Owner Owner's Name information is required for every Centerville Ma 02632 7//28/13 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 32' 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 hone within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: I You must describe how you established the high ground water elevation: Town Records Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 P — Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments M 29 Longview dr Property Address Frank Ciliberto Owner Owner's Name information is required for every Centerville Ma 02632 7/128/13 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information—Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins-3113 Title 5 Official InsJection Form:Subsurface Sewage Disposal System-Page 17 of 17 TOWN OF BARNSTABLE �, � � �. LOCATION � L/,� � �� SEWAGE # "�- s VII:LAGE "' ;_�- ASSESSOR'S MAP & LOT �Z .�� INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY /6 LEACHING FACII.TIY: (type) (size) NO.OF BEDROOMS 3 BUILDER OR OWNER PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: t 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 p' g facility). Feet Furnished by � �� .� �y� �s J^ �- -�;� rr,,`` �� 1 W � � � +� �'J > a e \`� � 3 � , � , ASSESSORS MAP : TEST 1-10LE LOGS PARCEL : —?s FLOOD ZONE: ti SOIL EVALUATOR ��lti IZ � 1) The installation shall'conjl,., with "1"itle V and 'Town of-�VVf Hoard of _ _.__w-. _u..„ m•...,. W I TNESS : W7 health Regulations. REFERENCE: DATE:. 1 2) 1'he installer shall verify the location of utilities, sewer inverts and septic r m PERCOLAT I UN RATE: - Z.�t4•E, I , coponents prior to installation and setting base elevations. j �j iZ � -y �. 3) All gravity septic piping to be 4 inch Sell 40 PVC at 1/8"per foot. Tlie first g two feet out of the d-box to the leaching shall be level. 2 TH- I , TH-2 4) This plan is not to be utilized for property line determination nor any other n riu, �r purpose other than the proposed system installation. Zo lz 5) All septic components must meet Title V specifications. I _ R corn�6) Parking shall not be constructed over I110 septic onents. lb 32 -Z p l (� 7) The property is bounded by property corners and property lines. LOCATION MAP 10 �� , i ,� 8) The property owner shall review design considerations to approve of total design flow and number of bedrooms to be considered for design. Receipt of payment for the plan and installation based on the plan shall be deemed �I f d f'� /r, approval of the design flow by the owner. 9) "The existing leaching or cesspools shall be pumped and filled with material per Title V abandonment procedures. Those within the proposed SAS shall be removed along with contaminated soil and replaced with clean sand per 47 47 108.6 D 3hb Z 14 v Title V specs.r 10)System components to be 10 feet from water line. Sewer lines crossing the .►' i I(� water line shall be sleeved with 4 inch SCI1 40 PVC with ends grouted if OVERHEAD WIRES _ — _ -- applicable. The proposed SAS is being installed below the water service - — — SEPTIC S 'STEM DES ] GN line. The line is to be sleeved as aforementioned and maintained in place. 11) If a garbage grinder exists it is to be removed and is the responsibility of the • I Y owner to ensure such. LOT O Sq Ft, w` ,r� FLOW ESTIMATE ! ' 12)The installer is to take caution in excavation around the as line if such �0 G-- G S exists. g 61,95 BEDROOMS' AT 11D GAL/DAY/BEDROOIA - GAL/DAY 13)The installer shall verify the location, quantity and elevation of the sewer lines exiting the dwelling`prior to the installation. SEPTIC TANK 14)This plan is representative only that a system can fit on a property meeting Title V requirements. GAL/DAIS x 2 DAYS GAL gR1CK WA�-K X 6465 0 USE I vALLON SEPTIC TANK X63.94 "[ amo G PIP,pGE 3.49 I -SOIL ABSORPTION SYSTEM ✓✓ 62 5g X�B LU J 40 X 2.39 O i N gR1CK - 2� X6 p - ..,.:� ,- _..r--._ _ � • .__Y - ---- -- -- -=�ie1=' -= _ 0 4.21 ARKiNG 6 `p I t (j� �JTj ' ""' �(/U U� ► _—• _ _ $- . �- fy��s ,' r Ln F g0 / 19 a 0AViD X 61 C).92 6° 59, SIDE Al1EA: SHED B wA�K 61.49 3 Sg BOTTOM AREA: L ,� t� 7-3 6 62 i, 61:32 ,� �� X 59.6 X 8.1 1 SEPTIC!- T ( C S o 5g. STEM SECTION G, ti 61 09 o � - �O 3 3 M. 0 6C — CP 0 G Ja CN 59 0 OpOR err 5� s� 1 8 g 1 8 5g X5 r ' �f 1 �U,q-2 � 10 A 19 .,.5h:2�_ _ � � b �J�VtL. � �� -BOX ' +�, � • ►�1►1 56 21 °R�vE I } f SAL AIC2 TES ' 1 VET 6, "' 5 GRA . .r SEPTIC TAi4IC .- . , . i 110.1401 ry . _ / 6.2.3 g0 5 .2� 22 �w t.' ;?. . " 54 cs �X� 56 �5-� 91 fit OR - X 3 6 �� 53 5 N DR 1 4�P /Z.Ra -- X 5"L Clot d'ls I"�' l l 00 NO, 8 53 ..• w ^ -- No wENA 5 31 TE AND S EV�IAGL P LAN AREA nRA�NAGE 58 41 a� A f� - r ' L 0.. I 0 N ��1 11 , a - �� -� P LPARED FOR : 1 ,, SCALE DAV I D B , MASGNAS DATE: 2 I. DBC ENVIRONMENTAL DES I GHS L,"AliT SANOW 1 CFI . MA DATE nal-Ill AGENT ( 506 ) 833- 2177 Z ' a _ Z LI 3 1 l