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Home My WebLink About0024 MIDWAY DRIVE - Health 24 MIDWAY-E VE Hyannis A = 252 ' 064 a �I i I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)'are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system.required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND(Explain below): 0 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 ,o Title 5 Official Inspection Form pie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 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 ppmi 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.7126/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® . 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 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. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis.[This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and.the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ® The system is a cesspool serving.a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. ` For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts ,�,p Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont) If you have answered "yes"to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate.regional office of the Department. 6. You must indicate "yes" or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑- Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of breakout? ® ❑ 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 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) 1310 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 1p Title 5 Official Inspection Form 6 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 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)): '19- 10 GPD 18- 0 GPD Detail: Sump pump? ❑ Yes ® No :Last date of occupancy: Date t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts IF Title 5 Official Inspection Form ,o Subsurface Sewa a Dis osal - g p System Form Not for Volunta Assessments Y ry 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form ; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF -281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown State Zip Code Date of Inspection D. System information (cont.) 4. Type of System: ® Septic tank,distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy. ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and ` maintenance contract(to be obtained from.system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate a e of all components, nents date installed if known n r 9 and source of information:p ( ) 2013 PER PERMIT AT BOH Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building.Sewer(locate on site plan): Depth below grade: 14"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.): LINE CHECKED WITH SEWER CAMERA AND WAS FOUND TO BE CLEAN AND.PROPERLY PITCHED t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form Fie Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 61,feet Material of construction: ® concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 GALLONS Sludge depth: lit Distance from top of sludge to bottom of outlet tee or baffle Scum thickness 1 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? ESTIMATED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 GALLON TANK IN GOOD CONDITION. TEES IN PLACE AND CLEAN. TANK AT NORMAL OPERATING LEVEL. COVERS 6" BELOW GRADE t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE . Property Address ANN GUTTENDORF.-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cost.) 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 g 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 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11'of 18} t Commonwealth of Massachusetts ,@ Title 5 Official Inspection Form ,o Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert EVEN Comments (note.if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): DISTRIBUTION BOX LEVEL AND WATERTIGHT t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 Commonwealth of Massachusetts ig. Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 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: El leaching galleries number: ❑ leaching trenches number, length: ® leaching fields number, dimensions: 21-ARC 8.6'X35' ❑ 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 1,3 of 118 Commonwealth of Massachusetts �a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-28.1 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's•Name information is required for every HYANNIS MA 02601 4/7/2020 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.): 21-ARC 36 HC H-20 RATED FIELD FOUND DRY. 12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doc-,rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts I(,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments W 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 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.): J t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 16 Commonwealth of Massachusetts Title 5 Official Inspection Form ` Subsurface Sewage Disposal System Form-.Not for Voluntary Assessments �,•/ 24 MIDWAY DRIVE Property Address Owner ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 information Owners Name is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100.feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately • A r _LFn 13.a C-3=16 I , Q Dex k 3 C,�=off t . A C Gurar�, 4 Tw V I 0 O F. f 1 i i L u G . 1 i I { i t5insp.doc•rev.7/26/2018 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts ► Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. Cityrrown 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: +12' feet. Please indicate all methods used to determine the high groundwater 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: INSTLL PERMIT AT BOH FROM 2013 ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database -explain: You must describe how you established the high ground water elevation: PLANS ON FILE FOR SEPTIC INSTALLATION IN 2013 STATES NO WATER ENCOUNTERED 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 Commonwealth of Massachusetts ,p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127. Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: ® A. Inspector Information: Complete all fields in this section. ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked Z 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 Commonwealth of Massachusetts aSa Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ; 24 MIDWAY DRIVE �,F "emu Property Address t ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 r Owner Owner's Name information is required for every HYANNIS-'� MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. Inspector Information 64 Lt OE on the computer, use only the tab Christopher Maki key to move your Name of Inspector cursor-do not Cape Cod Septic Services use the return Company Name key. 350 Main St. Company Address W Yarmouth MA 02673 City/Town State Zip Code reuun 508-775-2825 SI-14423 Telephone Number License Number B. Certification. I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CMR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above; the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving Authority 4. ❑ Fails ar 4/8/2020 Inspector's Ign re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP) within 30 days of completing this inspection. If the system has a design flow.of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies.sent to the buyer, if applicable, and the approving authority. Please note: This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 Commonwealth of Massachusetts lid Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 24 MIDWAY DRIVE Property Address ANN GUTTENDORF-281 WEST SEVENTH ST BOSTON MA 02127 Owner Owner's Name information is required for every HYANNIS MA 02601 4/7/2020 page. City/Town State Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: SYSTEM IS IN WORKING CONDITION 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. if"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound; exhibits substantial infiltration or exfiltration or tank failure is imminent. System.will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 r Town of Barnstable Barnstable �pP SHE Tp�� Board of Health j e"a�j 1639. BARM S-rSA6LE.$ 200 Main Street, Hyannis MA 02601 O Af 0 D MAI pie 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi February 20, 2013 Mr. Michael Pimental, E.I.T. JC Engineering, Inc. 2854 Cranberry Highway East Wareham, MA RE: 24 Midway Drive, Hyannis A = 252-064 Dear Mr. Pimental, You are granted a conditional variance on behalf of your client, James C:;Jones, to construct an onsite sewage disposal system at 24 Midway Drive, Centerville. The variances granted are as follows: 310 CMR 15.405 (1)(a): To install a soil absorption system zero feet away from the property line, in lieu of the minimum 10 feet separation distance required. This variance is granted with the following conditions: (1) No more than three (3) bedrooms are authorized at this property. Dens, study rooms, offices, finished attics, sleeping lofts, and similar-type rooms are considered "bedrooms" according to the MA Department of Environmental Protection. (2) The {applicant shall record a properly worded deed restriction, signed by the owner of the property, at the Barnstable County Registry of Deeds restricting the property to three bedrooms maximum. A copy of the recorded deed restriction shall be submitted to the Health Agent prior to obtaining a disposal works construction permit. Q:\WPFILES\VariancePimental24 MidwayDriveHannis2013.doc (3) The existing septic system components shall be abandoned properly, in accordance with the State Environmental Code, Title V. (4) The septic system shall be installed in strict accordance with the engineered plans dated December 27, 2012. (5) The designing registered sanitarian shall supervise the construction of the onsite sewage disposal system and shall certify in writing to the Board of Health that the system was installed in substantial compliance with the engineered plans dated December 27, 2012. This variance is granted because the proposed plan appears to meet the maximum feasible design standards contained within the State Environmental Code, Title 5 and local Health Regulations. The registered sanitarian had limited options available due to the locations of the existing structures (home and garage) on this very small lot. Sincer yours, Wa a 'r' Iler, M.D. Chairm QAWPFILES\VariancePimental24 MidwayDriveHannis2013.doc I - y��tiiE r41,I DATE: I V C FEE: `S.00 MAW 039.&�e� REC. BY Town of Barnstable c� SCHED. DATE: Board of Health 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Wayne A.Miller,M.D. FAX: 508-790-6304 Junichi Sawayanagi Paul J.Canniff,D.M.D. VARIANCE REQUEST FORM LOCATION Property Address: 2y W lLovy Lit We- CenA-ecdillc- 1 H ,� yZ (o3L Assessor's Map and Parcel Number: Hq 252- M 6 y Size of Lot: 71 7 96 r 5•F Wetlands Within 300 Ft. Yes Business Name: NIA No ✓ Subdivision Name: NI A APPLICANT'S NAME: 'SC- -6o�)ivi e ircv 1 j t i yiG, Phone .568- 273-6 377 Did the owner of the property authorize you to represent him or her? Yes I/ No PROPERTY OWNER'S NAME CONTACT PERSON Estate. of Lillian E. ;Tones Name: cto -Sarre-S C. 'apes Name: Hicm"4 Qime"VeA. tI7 Address: 3237 sw kcow"A P„e Qulrvt Cily,F, S1916 Address: 2-BM Cc"eaX �tR� ^/ ,E. UJardlawl� 0 6253 Phone: jet 4177- 9877 Phone: 508-273-0377 VARIANCE FROM REGULATION(List Reg.) REASON FOR VARIANCE(May attach if more space needed) ICE (.yeatve.c fcc Fccin Qm_ oserl _Out- to sPj+ee Af J-�e JcuP�LtkY b,-itween SAS 10 sui1�n ocr._oeAv kyle .(, i e. AXL e x(SMna dweW ns on oroo cE4 td�eC 3iD C=M(Z AJ,)-li d C-j O NATURE OF WORK: House Addition 0 House Renovation El Repair of Failed Septic System co CIO Checklist (to be completed by office staff-person receiving variance request application) q = ) Please submit copies in 4 separate completed sets. Four(4)copies of the completed variance request form i �O Four(4)copies of engineered plan submitted(e.g.septic system plans) C7 rn Completed seven(7)page checklist confirming review of engineered septic system plan by submitting engineer or registered sanitarian ` Four(4)copies of labeled dimensional floor plans submitted(e.g.house plans or restaurant kitchen plans) Signed letter stating that the property owner authorized you to represent him/her for this request _ Applicant understands that the abutters must be notified by certified mail at least ten days prior to meeting date at applicant's expense (for Title V and/or local sewage regulation variances only) Full menu submitted(for grease trap variance requests only) Variance request application fee collected(no fee for lifeguard modification renewals,grease trap variance renewals[same owner/lessee only], outside dining variance renewals[same owner/leasee only],and variances to repair failed sewage disposal systems[only if no expansion to the building proposed]) Variance request submitted at least 15 days prior to meeting date VARIANCE APPROVED Wayne Miller,Chairman NOT APPROVED Junichi Sawayanagi REASON FOR DISAPPROVAL Paul J.Canniff,D.M.D. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\BAJ9P9B7\VARIREQ.DOC DooR �y _ _� J �� J /� �� J � f� -� d % � o /� II � i ,. �, ° � �'�. � � � �' $ � � �� 3 s� �� P J G 0 �/ M ��a L/ O� r �� ``r^jv\ y c.COMPLETE - •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. X � ❑Agent ■ Print your name and address on the reverse ❑Addressee so that we can return the card to you. B. Received by'rPrirr Name) C. Date of�Delive7 Attach this card to the back of the mailpiece, � or on the front if space permits. ■ 1. Article Addressed to: D. Is delivery address d' item 1? ❑Yes If YES,enter delivery addre elow: ❑No Le ' 3. rvice Type Certified Mail ❑Express,Mail F Q �� Da( / Registered ❑Return Receipt for Merchandise V ( ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2 Article Number �01,0 1870 0 0 0 2 7201 3 0 7 8 1 Go e�06.0� (fiansfer from service la6eq; �� a . t PS Form 3611,February 2004 Domestic Return Receipt 102595-02-M-154p41 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this boxDw • Cape Englineienng,-Ilm 83 Maid' St. --Suite Cr Yarmouth Port, AAA 02675 'z�D f IJi��,,�I�I�ll��l��1�1�9�„1�1,„II�I�I►1�1��1��,1,1�1,,�,111 SENDER: • • COMPLETE • • DELIVERY E. Complete-items 1,2,and 3.Also complete A. Signature Agent item 4 if Restricted Delivery is desired. ,f q ❑ ■ Print your name,and address on the reverse X � f ❑Addressee so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. ` D. Is delivery address differentVm Item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No y c�`�b nG r� ��• 3. Service Type ❑Certified Mail ❑EVress Mail G 4 ✓v-'o/ ❑Registered ❑Return Receipt for Merchandise 1/0/ ❑Insured Mail ❑C.O.D. 1 0Cb 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 0,1,0. 18 7 0 0 0 0 2 7 2 01 3 0 61 G=U� crJ (Transfer from service labeq =; I ' Ps Form 3811,February'2004 Domestic Retum Receipt ft 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS i Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • III Down Cape Engineering,-inc. 939 Main,St. --Sulte C Yarmouth Port, MA 02675 it }I,.,,1111�Ii„L11�1„'tlll��t�i.,�r11t1�.IIt1111t}F:i�#�� :�,i. c SECTIONON SENDER: COMPLETE THIS SECTI COMPLETE THIS DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sign lure Item 4 if Restricted Delivery is desired. X ❑Agent ■ Print your.name and address on the reverse ❑Addressee so that we can return the card to you. B. Recei d (Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from Item 1? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑No JGti�o� 3. S rvice Type M ,q Certified Mail ❑Express Mail a ✓l vL44 1 I` [mmq Registered ❑Return Receipt for Merchandise I I 6 a 6 I ❑Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7 010 18 7 0 0002 7201 3085 ' (fransfe rfmm service label) - � PS Norm 3811,February 2604' ''' ' Domestic Retum Receipt 102595-02-WIS40 1 ' I UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No.G-10 • Sender: Please print your name, address, and ZIP+4 in this box • Down Cape Engineering 939 Main Street, Suite C '-' , Yarmouth Port, MA 0267.5 SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Si nature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we can return the Card to you. B. Be6e6ive (Printed Name) C.Pate of De ery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 17 Yes 1. Article Addressed to: / Y If YES,enter delivery address below: ❑No Pea / Ire e / 3. Service Type (�l1 ��'` 9'Registered ertiftfied Mail ❑Express Mail ❑Return Receipt for Merchandise ❑Insured Mail ❑C.O.D. d a 6 Yp 4. Restricted Delivery?(Extra Fee) ❑Yes j. (r6ftff�IM � 102595-02-M-15401 1 I UNITED STATES POSTAL SERVICE ,. Ft =1=itst:CiSs,Mail l ees Paid Permit Q b-1 o M; ' eM,.1 • Sender: Please print your name, addre g", and ZIF iri`'Iliis?P�t '"'" Dim Cape E. gineenng,llm 939 Main St. --Suite C Yarmouth Port, MA 02675 I Crocker, Sharon From: ."Crocker, Sharon Sent: Monday, December 31, 2012 4:00 PM__ To: mpimenteQcengi nee ringinc,cacn'--- -----.-_ ;1 / Cc: McKean, Thomas / Subject: Barnstable Board of He Ith -24 Midway Dr, Cent fl ti Michael, r- Wanted to let you know an abutter to above property informed me that the abutter's notice had an error in it. The property address "was stated as#25 (not#24). Please let me know if you will be sending out new notices. �S Thank you. Sharon �t Estate of: Lillian E.Jones 24 Midway Drive Centerville,MA 02632 December 21,2012 Board of Health Town of Barnstable 200 Main Street Hyannis,MA 02601 Re: Declaration of Authorization 24 Midway Drive,Centerville,MA 02632 Dear Members of the Board: Let it be known that I,James C.Jones,do hereby authorize JC Engineering,Inc.of East Wareham,MA 02538 to represent my interest regarding the upgrade of the sewage disposal system located at 24 Midway Drive,Centerville,MA in meetings both public and private. Sincerely, �d James C.Jones y LETTER OF TRANSMITTAL ..tr JC Engineering Inc. Civil&Environmental Services 2854 Cranberry Highway A' �b Telephone: 508-273-0377 E.Wareham,MA 02538 �- Facsimile: 508-273-0367 T0: Town of Barnstable DATE: 12/27/12 JOB NO. 2359 Board of Health RE: BOH Variance Package 200 Main Street 24 Midway Drive Hyannis,MA 02601 Centerville,MA 02632 WE ARE SENDING YOU: X Enclosed _ Under separate cover via X the following: Report Prints Brochures Shop Drawings Specifications Copy of Letter Change Order Forms Please find enclosed the followingyour review and approval: 1. four copies of an executed variance request form, 2. four copies of a septic system design plan dated December 27,2012, 3.)a signed representation authorization letter,4.)four labeled house floor plans, 5.)one executed Soil Suitabilit, Assessement for Sewage Disposal form, 6.)an executed check list, and 7.)one check for$95 (variance request fee). THESE ARE TRANSMITTED as checked below: X For Approval —Resubmit Copies for Approval For Your Use Approved as Noted Copies`for Distribution As Requested _Returned Approved as Submitted Returned For Review and Comment For Your Information REMARKS Should you have any questions,please feel free to contact our office. COPY TO: File 1 Ca ewide 1 SIGNED: Michael Plme I, E.I.T. Town of Barnstable - P# Departilnent of Regulatory Services STABLXF Public Health Division / arm. Date 11 �� 200 Main Street,Hyannis MA 02601 Date Scheduled / / / Time Fee Pd, D Soil Suitability Assessment for S a e Disposal Performed By:_��i G fi 06 P;m e,nU ,EI'(t �,� Witnessed By: G � LOCATION& GENERAL-INFORMATION Location Address Owner's Name L4 Ux J 04-tJ of ( w04� bQLVg.. l Address Assessor's Map/Parcel: Q Engineer's Name NEW CONSTRUCTION L [ REPAIR Telephone# �(��'Z`t �i;Z`l s��-273-0 377 Land Use: s'nsle �tlt au.Ct�ia� �' r SloPes(`�) Surface Stones Distances from: Open Water Body ft Possible Wet Area _ ft Drinking Water Well ft Drainage Way ft Property Llne 710 ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&pert tests,locate wetlands 3n proximity to holes) 5e2 N �c� P�art 9 Parent material(geologic) �u� bin Depth to Bedrock Depth to Groundwater. Standing Water in Hole:_ 1 12-d b9� Weeping from Pit Fgee t 2a b5 Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABT Method Used: DttecA O\,,X(o 4t.0,4 Depth Observed standing in obs.hole: 1 lu, Depth to Sgll tnottlea::. e ln, G7 Depth to weeping from side of obs,hole: In, Groundwater Adjustment Index Well# _ Reading Date: Index Well level z _..„ Adj,factor, ,y r Adj;-Groattdwater Level`s , PERCOLATION TEST bete sue2 xme a4n' Observation Hole# r Ui Time at 4" Depth of Peru 3.6- Jr y Time at 6" Start Pre-soak Time @ 10=U 7 All Time(9"-6") End Pre-soak fl):30 AN Rate Min/Inch L 7— y I Site Suitability Assessment: Site Passed Yes Site Failed: Additional Testing Needed(YIN) Original: Public Health Division Observation Hole Data To Be Completed on Back-------- ***If percolation test is to be conducted within 100' of wetland,you must first notify the, Barnstable Conservation Division at least one(1)week prior to beginning. QASEPOi'ICIPEROVORM.DOC DEEP.OBSERVATION HOLE LOG Hole# 142. Depth from Soil Horizon Soil Texture .Sdil Color Soil . Other Surface(in.) (USDA)- (Munsell) Mottling (Structure,Stones,Boulders. onsistcn::y.WOravel) b-t 2 .� •— 'F•l 12'1�( fklE GS ")oUcr3f2 36-t2U G µ-cS 2.5Y DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. DEEP OBSERVATION HOLE LOG Hole# Depth from . Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency, DEEP OBSERVATION HOLE LOG. Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones;Boulders, Consistency, Flood Insurance Rate.Map: Above 500 year t]ood•boundary No— Yes Within 500year boundary No Yes Within 100 year flood boundary No. Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? e If not,what is the depth of naturally occurring pervious material? Certification I certify that on �d`27��q (date)I have passed the soil evaluators examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required trainin ,expertise and ex l nce described in 310 CMR 15.017. Signature c Date 12-274Z QAS5EPTICTERCFORM.DOC ] r r Z `a w r . Ln Ln m Postage h C3 CerNNed Fee o p +mr Po"maYlt Return Receipt Fee Were (Endorsement_Required) �� / rq Restricted nt R. u Fee I ,.a (Endorsement Required) co t7 Total Postage&Fees r O h o Lillian E Jones h 24 Midway Drive -- Centerville, MA 02632 Certified Mail Provides: (eaeneli)aooaeonr'cosc-odsd o A malfing receipt p A unique identifier for your mailpl ece q A record of delivery kept by the postal'Senrice for two years ;important Reminders: o Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. a Certified Mail is not available for any class of international mail. a NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. Ford valuables,please consider Insured or Registered Mail. a For an additional fee,a Retum Receipt may be requested to provide proof of - delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for duplic a return receipt,a USPSe postmark on your Certified Mail receipt is o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted-DDelivery". 4 If a postmark on the Certified Mai(receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail .IMPORTANT:Save this receipt and present it when making ao inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. Barnstable Town of Barnstable . P� y AD-dm�icaC ity Regulatory Services Department A IBARNS-TABLE, 't NAB. G - -Public Health Division VVV VVV �A 1639. 2007 v rEb MPt a. 200 Main Street, y Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7006 0810 0000 3524 7458 November 7, 2012 Lillian E Jones 24 Midway Drive Centerville, MA 02632 . The septic system located at 24 Midway Drive, Hyannis,MA was last inspected on 10/30/2012 by Sean M. Jones, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: r • System is in hydraulic failure: You are ordered to repair or 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. � t PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\24 Midway Hy Nov2012.doc _ . .... ....................•-------.------Commonwealth of Massachusetts JQ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name - Information Is required for every �_ S- - ----- Ma 02632 10/30/2012 pa9e. Cityrl n State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forme may not be altered in any way.Please see completeness checklist at the end of the form. Important:When A. General Information r1 I, on the computer, $ use only the tab key to move our 1 Inspector. - �. cursor-do not Sean M. Jones use the return Name of Inspedor key. C y e Enterprises � Company Name 153 Commercial St Company Address Mashpee Ma 02649 _ Citylrawn State Zip Code 508477-8877 SI 4522 Telephone Number I leanse Number B. Certification 1 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 16.340 of Title 5(310 CMR 15.000).The system: � Y( 1-0. Q ❑ Passes ❑ Conditionally Passes ® Fails %J ❑ Needs Further Evaluation by the Local Approving Authority s _ 10/30/2012 a Inspector's Signature Date ro 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. ..r...L—1'y d000rllsoo ��..J:�:ono w��f.•�:...e si ina.p��:�� and unAer thm&-nnr i}innC of ufca at that time.This inspection does not address how the system will perform.in the future under the same or different conditions of use. �C70 tSlns 1no -M9 5 Offid 1n"9dVmb-3-w0fw4S6WW-D1*P0sel/Yaom-Page 1 a117 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 24 Midway Drive Property Address JONES, LILLIAN E Owner Ownees Name Information is required for every Centerville Ma 02632 1'01300012 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. hmportartt:when filling out forms A. General Information on the computer, use only the tab 1. Inspector. key to move your cursor-do not $ean M. Jones use the return Name of Inspector key. Capewide Enterprises ��.► Company Name 153 Commercial St yAddress Mashp - -- Mashpee Ma 02649 Cityrrown State Zip Code 508477-8877 S14622 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 16.340 of Title 5(310 CMR 16.000).The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 10/3MO12 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 oompledng 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. ""Tlri.. .ter...♦....I�r d•o•rlboo a ..J:a:•n• w•�i.•a:.we ei Sw��.....e:.... a~4 asnAgar th.IYand4ifinnn nf usta at that time.This inspection does not address how the system will perform.in'the future under the same or different conditions of use. [Sims•11/10 -Me 5 offtad InepeWon Font SUDgUrWA Sewspe 01sposW Systwn Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown 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: 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•11/10 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 24 Midway.Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 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 J ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in cesspool is less than 6" below invert or available volume is less than Y2 day flow t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd.. For large systems, you must indicate either"yes" or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 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 gpd t5ins•11/10 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 ;M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes ® No Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: unknownDate Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments GM , 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: 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•11/10 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 24 Midway Drive GSM SVBy`BW _ Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: unknown Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 1.5 feet Material of construction: ❑ cast iron ❑ 40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints ok, no leakage, vented through roof Septic Tank(locate on site plan): Depth below grade: .5 feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 6" t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 3' Y Scum thickness Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 10" How were dimensions determined? opened covers, took measurements 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 should be cleaned soon. Water level was at bottom of outlet but had signs of past overloading including scum buildup on top of the outlet baffle. 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•11/10 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 °M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown State Zip Code Date of Inspection' D. System Information (cont.) Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•11/10 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 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown 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.): N/A 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.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins-11/10 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 ,M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ® overflow cesspool number: 1 ❑ innovative/alternative system Type/name of technology: Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching facility consist of a block cesspool. The cesspool was found to have approx 1' of standing water. The interior walls of the cesspool had a large amount of root growth and scum stains indicating that it has been overfull in the past resulting in a failing inspection. 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•11/10 Title 5 Official Inspection Form:,Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ,M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. City/Town 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•11/10 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 24 Midway Drive Property Address JONES, ULLIAN E Owner Owner's Name ~.. iequire Lion is Centerville Ma 02632 1013o 2o12 required for every page. Cityfrown State Zip Code Date of Inspection 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 13 G • 4 f Q 0 2 3 22 thins•11110 Title 5 official kop¢ci+on Form 840surfnce S"09e q'epoeaf System•Cage 15 of 17 Ed WdOt7:60 ?TO? T2 '100 'ON XUd SSNOf'W'S: WONJ ✓ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 page. Cityfrown 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: 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: Groundwater elevation was not established. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 24 Midway Drive Property Address JONES, LILLIAN E Owner Owner's Name information is required for every Centerville Ma 02632 10/30/2012 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 i t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 A/ TOWN OF BARNSTABLE LOCATIONS�� / �p��V�, SEWAGE# Z a 1 3 0 7-�5! VILLAGES _ASSESSOR'S MAP 1&PARCEL 0 INSTALLER'S NAME&PHONE NO.�c�ic.Ui . ��'►1��0/+js�s C ��j��877 SEPTIC TANK CAPACITY 1000 60 LEACHING FACILITY.(type) 02 (6696 K.)hl dd (size) $, NO.OF BEDROOMS 3 OWNER,,Sj�afe_, 6f /� ,`rah �• 1011r,, f C16 Taygu C. Cjama.5 PERMIT DATE: I t Zo t 3 COMPLIANCE DATE: / 231d Separation Distance Between the: '/o Wa f er ecwn-fPreq ii 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) ✓" n Feet FURNISHED BY Ca�Z..t��i,� LP"✓S�f L(_C Al pra q,.g 93=3 3s _ � ,L�,Ic 3 C—�"d,qs �uilc s A p ® 01 JJ tA,n_� l � (� — dq LIv Fee o �� No T COMMONWE Entered in computtlP ALTH OF MASSACHUSETTS C L Yes PUBLIC HEALTH DIVISIOf --TOWN OF BARNSTABLE, MASSACHUSETTS application for BIStlo i .6pBtent Construction permit Application�t to Construct( ) Repair( U don( ) ❑Complete System ElIndividual Components Location Address or Lot No.a j t W`jDCjV4 D ner's Name,Address,and Tel.No. Assessor's Map/Parcel 9 Q (PA4 Installer's Name,Address,and Tel.No. 509—477—SETT Desiggner's Name,Address,and Tel.No. 17� y 0-3 77 l G 0W(" M W54V e'1E E Type of Building: �7 Dwelling No.of Bedrooms Lot Size "/ rl sq.ft. Garbage Grinder( ) Other Type of Building IZG51 6-W(A L— No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3 310 gpd Design flow provided 3`13 ,0 gpd Plan Date 1;),— \\Number of sheets l Revision Date Title + !'� M I D k4'4 U-(06 I�QJMZR C &Z�6 Size of Septic Tank 1 .O®o Type of S.A.S. Description of Soil 64ka-- i T '�1 l i�w^ILW 1 ems' " Nature of Repairs or Alterations(Answer when applicable)�` W G Ttw&,i (666 C—t (i �QP� , 1�p�/ 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. p Date 1 i�ao Application Approved by Date 1—( ��/J Application Disapproved by Date for the following reasons Permit No._7(j (? Qa�_ Date Issued �' •:�' O ��J�--� � � V � / �! h<(�/� Fee �yJ�- vG�fPPvtj/� No. -- 15 �� ( rl r fff THE COMMONWEALTH OF MASSACHUSETTS Entered in comput r.—�C PUBLIC HEALTH DIVISIOR�.-�_T0�11Ne"OF BARNSTABLE, MASSACHUSETTS Yes application for his o -a' Epstein Construction 3permit c Application fora Permit to Construct( ) Repair( U gra e(--) -Abandon( ) El Complete System El Individual Components f- - 1A a Location Address or Lot No. J Owner's Name,Address,and Tel.No. aK l��nc�� I.IU1(4" 700tiEs Assessor's Map/Pareel 2-5 d P- t Installer's Name,Address,and Tel.No. 509 477-9$'7 Designer's Name,Address,and Tel.No. �d�3 _03 7? Bte�t pE 1TVgPtL15CS ULC. �G ek*rNt:G21I� Q YUc. C 6WW r4SWP 05 a 8 LVY E P.ype of Building: Dwelling No.of Bedrooms Lot Size /7, rl 90 -- sq.ft. Garbage Grinder( ) Other Type of Building Rt:51b tTT(�l-. No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 3� gpd Design flow provided 3173 ID gpd Plan Date 11� -,�']. �1DI 1- \Number of sheets Revision Date Title 5 1 1)L—U&N Size of Septic Tank W o o Type of S.A.S. Description of Soil , 0-c3tac Nature of Repairs or Alterations(Answer when applicable) tj L, L IS T(&K-Z (doo (✓ C MD t)W K • Date last inspected: -, Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in �' r 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 ed Date l "'t6' 'cZ0 kI Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 13 Date Issued i - 0'/ 7 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 <2APffWI pE E�J�aJ5 LQQ at ._l s been constructed in accordance with the provisions of Title 5 and the for Disposal System Construc' n Permit No. 2O 1 -0 2S dated fT/ Installer eAPeo(D,6 6N)T60AESQ (.lSt Designer G L- JC=0�UJU(a- .)G. #bedrooms 3 Approved design flow 330 gpd The issuance of this permit shall not be construed as a guarantee that the system will function as desi�. I Date )I- q I Z.i Inspector / - -_- �v -------------------------------------------------------------------------- ------------------------------------------------------------ No. a 1 3 0 2 S Fee �v THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstem Construction 3permit Permission is hereby granted to Construct( ) Repair(x) Upgrade( ) Abandon( ) System located at a4 M I D LOW4( X1 UC and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with i Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. D� , J/ Date ( ! 1A roved b �v 1 !T/13 pP y 0 V i i I i Excerpt from the Board of Health Results— 1/15/13 B. Michael Pimentel, JC Engineering, representing James Jones, Trustee - Estate of Lillian E. Jones, owner— 24 Midway Drive, Hyannis, Map/Parcel 252-064, 7,790 sq. ft. lot, one setback variance. The Board granted the variance with the following conditions: 1) proper abandonment of the existing system, 2) record a 3 bedroom Deed Restriction at the Barnstable County Registry of Deeds, and 3) supply a proper copy of the Deed Restriction to the Public Health Division. B k 27055 F's346 �W4240 01--1S-2013 a 02% 8� 1 Property Location: 24 Midway Drive,Barnstable(Ce e),Barnstable County, Massachusetts DEED RESTRICTION WHEREAS, James C. Jones, of 3237 SW Seaboard Avenue, Palm City, Florida 34990, Personal Representative of the Estate of Lillian E. Jones, late of Barnstable (Centerville), Barnstable County, Massachusetts, Barnstable County Probate Docket No. BA12P1476EA, is the owner of 24 Midway Drive located in Barnstable (Centerville), Barnstable County, Massachusetts (hereinafter referred to as "the Property"), and being shown on a plan entitled "Midway" a Residential Subdivision in the Wequaquet Lake Area, Centerville, Cape Cod, owned and developed by Leo W. & Evette T. Gregoire, Scale: 40' = 1", February, 1959 Ed Kellogg, Osterville, Engineer, duly recorded with Barnstable County Registry of Deeds in Plan Book 147,Page 73; WHEREAS, James C. Jones, Personal Representative of the Estate of Lillian E. Jones, as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction as to the number of bedrooms which can be included in any home built on said lot as a pre- condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 Prepared by the Law Office of Patricia J.Mello,P.C. 766 Falmouth Road,Mashpee,MA 02649 508-477-0267 1 SPKVDPL&A State Environment Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environment Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; and authorizing the issuance of a building permit for the construction of a single family home on this Property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document; NOW THERFORE, James C. Jones, Personal Representative of the Estate of Lillian E. Jones, does hereby place the following restriction this above referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. 24 Midway Drive, Barnstable (Centerville), Barnstable County, Massachusetts may have constructed upon the lot a house containing no more than three (3) bedrooms. James C. Jones, Personal Representative of the Estate of Lillian E. Jones, agrees that this shall be a permanent deed restriction affecting the Property located on 24 Midway Drive, Barnstable (Centerville), Barnstable County, Massachusetts and being shown on the plan recorded in Plan Ronk 1Q2 P,__age.71 For title see Deed recorded with the Barnstable County Registry of Deeds in Book 26662, Page 187. See also Estate of Lillian E. Jones, Barnstable Probate Court Docket No. BA12P1476EA. Prepared by the Law Office of Patricia I Mello,P.C. 766 Falmouth Road,Mashpee,MA 02649 508-477-0267 2 SPKVDRL&A EXECUTED AS A SEALED INSTRUMENT this r ( day of 2013. J C. Jones, Per o epresentative of the Estate of Li an E. Jones STATE 0F+h0R2fl3-A M6rh&,-A-M ss On this day of 74nQMA 2013, before me, the undersigned notary public, personally appeared the aforementiones C. Jones, as Personal Representative as aforesaid, and proved to me through satisfactory evidence of identification, which was 1- personal knowledge of identity or 7)-f,fvve 5 -C� -3-oy-)e Ito be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose. CARMEN.RAMIREZ NOTARY PUBLIC.-STATE OF MICHIGAN- COUNTY OF VAN BUREN My Commission Expires April 23,2019 Acting-in-the-Cwnty o Prepared by the Law Office of Patricia J.Mello,P.C. 766 Falmouth Road,Mashpee;MA 02649 508-477-0267 3 SPKVDRL&A Towwof Barnsia'Ule P# 7 C , g Department of Regulatory:Services 1 ` F Publie Health Division Date A,///,g- MAEA, 200 Main Street,Hyannis MA 02601 Date Scheduled /�J/ / Time Fee Pd. O v Soil.Suitability Assessment for S a e Disposal Perfmaud•By: lyiGha4l ecOlelie,( ,t t1-GSE Witnessed By: LOCATION 4.0ENERAL INFORMATION Location Address Owner a Name iA LL Ste, W6�yaDRIU� . 1r M1Ad�tesek ol4 5'�.i d�,( 1 kV" 4,� .L';yL,ye r�•'' .,� ate, : Aseesdor'a Map/Parcel: 55,1 /o 6"f Engineer's Name C A peju rD& &;oTa4p is +51:e1511 I09 NEW.CONSTRUCTION REPAIR Telephone#' 66,4'1 Z- 7 508-273-0 377 Land Use StnSle(Vmi Au clli 0^ ( — y � Slopes(%) Surface Stones Distances from: Open waterBody R Possible Wet Area — ' R Drinking Water Well _ R Drainage Way R Property line '7 10 R Other R SKETCH:-(street name,dimensions of lot c"ct location of,teat holes Bc-perc teats;locate,weuenda{a proximity ro bolts) t �. Pamt material(geologic) Dl7kkGt�1 Depth to Bedrock 7.120 b,55 Depth to Oroundwater. Standing Water in Hole: 120'to93 Weeping from Pit Face 7 120. > Had mated,Sessonat High Groundwater 7 l'20 ns DETERMINATION FOR SEASONAL HIGH WATER TAB£ Method Use&. txt 6 6xtua4ton Cn O Depth Observed standing in obs..hole: 1 e in. Depth to soil moulm. At, C> Depth to weeping from side of obs.hole: — In. Oroundwater Adjustment Index Well# _ Reading Date: Index Well level -" _,., Adj factor 'AdjI G UR iiiLaval-W s, PERCOLATION TEST" naia 2.19-11 Observation Hole# Time at 9" I y ^ l Depth of Pest 3 b` .511 71tne at 6" c Start Pro-soak Time® 10:0 7 All 1 71mo(9"41) End Pro-soak /0 1c A)l Rate:MinJlnch Z Site Suitability Assessment: Site Passed �� Site Failed: — Additional Testing Needed(Y/N) N Original: Public Health Division Observation Hole Data To Be Completed on Back ***If percolation test is to be conducted within 100'of wetland,you must first notify the. Barnstable Conservation Division at least one(1)week prior to beginning. QASEPTICIPBRCFORM.DOC DEEP.OBSERVATION.HOLE.LOG. Hole# 1+2- Depth from Sell Horizon Soil Textprc Shcl Color Soil Otba Surface an.) (USDA). (Munseln Mottling „(Sttaeluro,Stonei;Boulders. /0YI312 t4b 6 cS IQYrs/b 3(o i2p G H CS 2.5Y`°46 — /005C- DEEP OBSERVATION.HOLE LO.G_ Hole# Depth from Soil Horizod ` Soil Texture Soil Color Soll Other..' Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. .:_... Consistency, _ DEEP OBSERVATION HOLE LOG` Holt; Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(lu.) (USDA) (Munsell) Mottling (Swcture Stones,Boulders. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon SoilTcxture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Sbwturo,Stones.Boulders. i Flood Insurance RateME: i. �A"e..64..,3 k, .:vd�+': (.,.�7'xq v, - . Above 500 year tlood.boundary No— Yes ._ Within S00 year boundary No✓ Yes, . Within too yearfiood'boundary No. Yes Depth of Natura➢v Occurrine.Pervious Material Does at least four fief of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? BS If no%what is the depth of naturally occurring pervious material? Certification I certify that on �0 17"99 (date)I have passed the soil evaluatopexamination approved by the Department of Environmental Protection and that the.above analysis was performed by me consistent with . the required training,expertise and ex nce described in 110 CMR 15.017. Signature Datb 12 QaSEPT IOMRCPORM.DOC Town of Damstable Regulatory Services 4 Thomas F.Geller,Director r' Public Health Division Thomas McKean,Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Date: 1 2-S- 13 Sewage Permit# Z°t3-Z-S Assessor's Map/Parcel 252- G y Installer &Designer Certification Form Designer: �TrC. Installer: C-aec tde- E,�Eer�ciszs Address: 2854 C roA\oerry 1k�*2wu_ Address: 15.3 Co rvw- ruy--t. STc`-vt Eoel IAJfr6nom. t1A 02538 t�FS`'►PZ� vvt✓4 020'-(q 5a8-273•-6377 T— On At I Zo 13 c, 2i,�11 dQ t, er��n1-cs was issued a permit to install a (date) (installer) septic system at 2-q Hcliuiar P<<'Ue. based on a design drawn by (address) G ,.En5tsleer�n , The. dated Dac"ozr 21, 24t2 designer) >� I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank, 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 required) ` ected and the soils were found satisfactory. TM� JOHN CH HILL y n ler's Signature) ML ` 4160 e signer's Signature (Affix De gn Here) P E RETURN TO ARNSTABLE PUBLIC HE 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. gAofFee forms\designercenification form.doe T.O.F. EL.= 75.5'± INISH GRADE OVER D-BOX= 73.1'± 4"SCHEDULE 40 PVC MIN. SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 7.3.0' - 73.3' GENERAL NOTES fPROVIDE EXTENSION RISER SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH ACCESS BOX TO WITHIN 3"OF 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6" OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE F.G. (ONE PER OUTER ROW) METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL @ FND. EL.- 74.1 ± F.G. OVER TANK EL. = 74.0 ± 5" DIA. OUTLETS) CODE AND ANY APPLICABLE LOCAL RULES. _ _ _ _ f . 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE DESIGN ENGINEER. EXISTING PROPOSED 4" 9"MIN. 9"MIN. 36"MAX. 36" MAX. TOP OF SAS/B.O. = 70.73' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE -� PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. -�" 3" DROP MAX " PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 6 3 2" DROP MIN 3 9 L = 55± JOINTS (TYP.) ELEVATION =70.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A MIN.SLOPE(off 1 101, E4" PVC IN FROM 1.33' " 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" \-*72.1'± PTIC TANK 4" PVC OUT TO 0 (TYP.) 10.75". j1w A i TYP 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION. O LEACHING FACILITY 90 ( ) l 5. SLOPE ALL SOLID PIPE AT 1.0% MINIMUM. 1 CONTRACTOR CONTRACTOR SHALL OUTLET TEE 70.67' MIN. 6,. 70•50' 70.30' �- 69.40' (laid flat) 2.875' (34.5")--I 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE 5'0' FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) 5 MIN. 8.625' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY i COMPACTED BASE REQ'D 35.0' AND DESIGN ENGINEER. 1 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. ELEVATION OF 73.80, TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV= < 63.30' BIODIFFUSERS (END VIEW) ESTABLISHED ON TOP OF A NAIL SET IN A TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERSPROFILE 9• CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION ( ) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES *CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR SEPTIC TANK PROFILE DISTRIBUTION BOX DETAIL ARC 36HC (#3616BD) BIODIFFUSERS (H-20) TO THE DESIGN ENGINEER. TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING * f e TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM a n '\,11 ►'# PERC NO. 13830 APPROPRIATE AUTHORITY. 1_ INSPECTOR: Donald Desmarais, RS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS MAP 252 EVALUATOR: Michael Pimentel, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE j� LOT 63 ha 4 C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. - N81°53'10"W = i DATE: December 19, 2012 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 74.36' MAP 252 7 TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE X X X--n_ _ LOT 62 MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. FENCE �j X X x - ELEV TOP= 73.30' REPLACE ALL UNSUITABLE MATERIAL WITH CLEAN COARSE SAND FREE FROM CLAY, / \ ( P.) -X_X X 1 ! ` • ELEV WATER= <63.30' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). 2 min./inch/ N� �` X • • _ _ _ PERC RATE - < 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN /1 - SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. f ;�' �I • • ZONE 2 DEPTH OF PERC= 36"- 16. PROPOSED PROJECT IS LOCATED WITHIN: � I I ' • `• � MAP 252 f 3 nd •. •• �� ,� .� I TEXTURAL CLASS: 1 ASSESSOR'S MAP 252 PARCEL 64 LOT 64 • • �l b ` w OWNER OF RECORD: ESTATE OF LILLIAN E. JONES . �r \ W r . ► c/o JAMES C. JONES o f` 7,790 S.F. ± • • , ' :! 0" 73.30' 0- � ^ f • • 4 • • ) ADDRESS: 24 MIDWAY DRIVE 0 40o x ' •+ . : • • ,�►� � C + ` ••, , r Fill 72.30' CENTERVILLE, MA 02632 \ 2 f • • • • • , + /1 'LOCUS : 12 • Loamy Sand FEMA FLOOD ZONE C _/ x • ' f 11 A/E x 10Yr 3/2 COMMUNITY PANEL# 250001 0005 C 9 M • • . • dl . �-,' 14 72.13 #24 x , . ` �� • , �+� • C ! 17. DEED REFERENCES: j EXISTING I x • , • ; ' Z f r • Loamy Sand 1.)COURT DOCKET No. BA12P1476EA B 3-BEDROOM l -EXISTING 1,000 GALLON ., • • I/�� !1 1 10Yr 5/6 2.)DEED BOOK 26662, PAGE 187 Q Q DWELLING x SEPTIC TANK TO BE a • ; • , �t • • • 36" 70.30' 18. PLAN REFERENCE: PLAN BOOK 147, PAGE 73 w,� TOF = 75.5'± X UTILIZED IN THIS DESIGN r • • . . j O • • _ _• : • Perc O ``\w x C6 • • � ` • r ' ' 54' 68.80' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. o O I a cgs d a I f ". • . 20. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL W / ' w « • • • • NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. / 4t X ' - Medium -Coarse Sand 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405,THE FOLLOWING LOCAL UPGRADE X C 2.5Y 6/6 o (loose) APPROVAL IS REQUESTED FROM 310 CMR 15.211: 1.) A 10.0'WAIVER (10.0--0.0') FOR THE SETBACK FROM THE PROPOSED LEACHING SYSTEM LOCUS PLAN CH/ o 0 M coo TO THE SOUTH PROPERTY LINE. MAP 252 SCALE: 1" = 1000' WALK 120" 63.30' �- ❑/H/ ,t LOT 65 U.P.#2 �- Q/H/W / /� X No Mottling, Standing or Weeping Observed DECK"ITpRIVEI,yAY DESIGN DATA TEST P I T1 DATA LEGEND O f PERC NO. -4- / ( F x INSPECTOR: Donald Desmarais, RS \ / GARAGE j EVALUATOR: Michael Pimentel, EIT, CSE 50xO' EXISTING SPOT GRADE / � a X NUMBER OF BEDROOMS (DESIGN) 3 \ l , f C.S.E. APPROVAL DATE: Oct. 1999 >< DESIGN FLOW 110 GAUDAY/BEDROOM - - - 50 ! - -- EXISTING CONTOUR 4- BUSH (TYP) HC-2 _ x DATE: December 19 2012\ - TOTAL DESIGN FLOW 330 GAUDAY PROPOSED CONTOUR N I TEST PIT#: 2 .a co DESIGN FLOW X 200 % = 660 GAUDAY l HC-1 x ELEV TOP = 73.30' ❑/H/W EXISTING OVERHEAD UTILITIES y_ \ TP 1 f USE EXISTING 1,000 GALLON SEPTIC TANK 4- �` 73x3' TP 2 k ELEV WATER= <63.30' (4 73x3' o SHED f - GAS EXISTING GAS LINE 35.0' x PERC RATE W W EXISTING WATER LINE_ \�.� I 1) - j INSTALL 21 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC \ �� / TEXTURAL CLASS: 1 TEST PIT LOCATION N81°53'10"WV 'l Qy \\ _ 62.14' ( x EXISTING LEACHING PIT TO BE ____. �\ c9�, 73-, l,. 3) PUMPED AND FILLED WITH CLEAN, SYSTEM CAPACITY O O O EXISTING 1,000 GALLON SEPTIC TANK �\ " " \ / ) \ k COARSE SAND &ABANDONED (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 73.30' TREE (TYP" ^ (2 (105.0')(4.8 SF/LF)(0.74 GAL/SQ.FT.)= 373.0 GAL. LEACHING/DAY Fill - PROPOSED 4"SOLID SCHEDULE 40 PVC PIPE O \ GqS _M 12" 72.30' PROPOSED DISTRIBUTION BOX SAS L.P. TYP X- F: AS _ _ x TOTALS: Loamy Sand A/E V X X X-X-Xj TOTAL NUMBER OF BIODIFFUSERS: 21 10Yr 3/2 GAS " Q PROPOSED ARC 36HC (#36166D) H-20 BIODIFFUSER V_- _ _--_ � -�_ - SAS TOTAL NUMBER OF COUPLINGS: 0 14 72.13 -�- G �72i TOTAL LEACHING AREA: 504.0 Loamy Sand PROPOSED INSPECTION PORT W'-- TOTAL LEACHING CAPACITY: 373.0 B 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION - - WITH ACCESS BOX (TYP OF 2) APPROX.�O - G W ,y 36,. 70.30' 1 ►�� PROPOSED SEPTIC SYSTEM UPGRADE PROP. TOTAL 21 ARC 36HC Benchmark PROPOSED DISTRIBUTION BOX NOTE PREPARED FOR: (#3616BD) H-20 BIODIFFUSERS EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE �►' =r \ IN A FIELD CONFIGURATION -i Nail Set in Oak Tree " N L. "' 0 Elev. =73.80' DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER JAMES C. JONES ti Medium -Coarse Sand CHU . HILL JR. MODIFIED APPROVAL FOR GENERAL USE ISSUED TO INFILTRATOR o� Approximate MSL C � o SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6 �a a 06 MIDWAY DRIVE MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. (loose) `ass T ` LOCATED AT ❑,HIV U.P. ❑/H/W (40'WIDE LAypUr) 24 MIDWAY DRIVE E �- � G- ❑/H/V EfdTERVILLE, MA 02632 /HIV � -----.._. .._--- NOTES: ❑/HiW 120" SCALE: 1 INCH = 10 FT. DATE: DECEMBER 27, 2012 1.) MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC SWING-TIES s3.3o' 0 5 10 20 40 FEET SYSTEM COMPONENT. No Mottling, Standing or Weeping Observed �H°f N14 DESCRIPTION HC-1 HC-2 JOHN L. PREPARED BY: 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED BIODIFFUSER CORNER(1) 16.1' 36.9' RESERVED FOR BOARD OF HEALTH USE CHURCVILL JR JC ENGINEERING, INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS 418 2854 CRANBERRY HIGHWAY PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT BIODIFFUSER CORNER(2) 22.5 40.6 I CONSISTENT WITH TEST PIT DATA. BIODIFFUSER CORNER 3 29.0' 20.8' F' F 'ST EAST WAREHAM, MA 02538 3.) PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY DISTRICT SITE PLAN O 508.273.0377 AND THE ESTUARINE WATERSHEDS. SCALE: 1"= 10' BIODIFFUSER CORNER(4) 24.4' 12.1' i Drawn By: DDS Designed By:MCP Checked By:JLC JOB No.2359 T.O.F. EL.= 75.5'± INISH GRADE OVER D-BOX= 73.1'± 4"SCHEDULE 40 PVC MIN_ SLOPE 1 % FINISHED GRADE OVER BIODIFFUSERS= 73.0' - 73.3' GENERAL NOTES fPROVIDE EXTENSION RISER SLOPE @ 2% MIN. WITH COVER OVER INLET& REMOVABLE WATER-TIGHT COVER OVER INSPECTION PORT WITH 1. UNLESS OTHERWISE NOTED, ALL SYSTEM COMPONENTS AND CONSTRUCTION FINISH GRADE OUTLET TO WITHIN 6"OF F.G. RISER TO WITHIN 6"OF FINISHED GRADE ACCESS BOX TO WITHIN 3"OF METHODS SHALL BE IN ACCORDANCE WITH TITLE 5 OF THE STATE ENVIRONMENTAL ' F.G. OVER TANK EL. = 74.Q�± /-5" DIA. OUTLET(S) F.G. (ONE PER OUTER ROW) CODE AND ANY APPLICABLE LOCAL RULES. 2. ANY CHANGES TO THIS PLAN MUST BE APPROVED BY THE BOARD OF HEALTH AND THE 1 DESIGN ENGINEER. EXISTING 4" PROPOSED 4" 36"MAX. 39" MAX.N. TOP OF SAS/B.O. = 70.73' 3. 4"SCHEDULE 40 PVC PIPE WITH WATER TIGHT JOINTS SHALL BE USED IN DISPOSAL SEWER PIPE PVC SEWER PIPE SYSTEM UNLESS OTHERWISE NOTED. 6" 3" 3 DROP MAX 3" 9„ PROVIDE WATERTIGHT 4. TO PREVENT BREAKOUT, THE PROPOSED FINISHED GRADE SHALL NOT BE LESS THAN 2" DROP MIN MIN.SLOPE(r�1% L = 55± JOINTS (TYP.) ELEVATION = 70.73' FOR A DISTANCE OF 15'AROUND THE PERIMETER OF THE SAS. UNLESS A 10" 4" PVC 't IN FROM 1.33' 40 MIL GEOMEMBRANE LINER IS PLACE AT LEAST FIVE FEET FROM S.A.S.AND THE TOP OF 14" *72.1'± SEPTIC TANK 4"PVC OUT TO (TYP.) 16 THE LINER IS NOT LESS THAN THE BREAKOUT ELEVATION, O LEACHING FACILITYL I f 0.90' P1O7P) o 5. SLOPE ALL SOLID PIPE AT 1.0 /o MINIMUM. CONTRACTOR CONTRACTOR SHALL OUTLET TEE 70.67' MIN. 6" 70,50' 70.30' �-- 69.40' (laid flat) 2.875'(34.5")_- 6. THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL. SHALL VERIFY SIZE 48" VERIFY CONDITION OF \ 50' (TYP.) 7. LOCAL BOARD OF HEALTH AND DESIGN ENGINEER TO BE NOTIFIED PRIOR TO BACK � . AND CONDITION OF EXISTING TEES GAS BAFFLE 6" CRUSHED STONE FILLING WHEN SYSTEM IS NEARLY COMPLETE AND READY FOR INSPECTION. SYSTEM IS EXISTING SEPTIC AND REPLACE AS OVER MECHANICALLY (TYP.) 5' MIN. 8.625' NOT TO BE BACK FILLED WITHOUT FIRST OBTAINING APPROVAL FROM BOARD OF HEALTH TANK NECESSARY COMPACTED BASE REQ'D 35.0' AND DESIGN ENGINEER. 5 OUTLET DISTRIBUTION BOX (TYP.) 8. ELEVATIONS BASED ON APPROXIMATE MEAN SEA LEVEL DATUM. ELEVATION OF 73.80, TO BE INSTALLED ON A LEVEL STABLE GROUND WATER ELEV.= < 63.30' BIODIFFUSERS (END VIEW) ESTABLISHED ON TOP OF A NAIL SET IN A TREE AS SHOWN ON PLAN. BASE. FIRST TWO FEET OF OUTLET 9. CONTRACTOR SHALL VERIFY ALL UTILITY LOCATIONS PRIOR TO CONSTRUCTION EXISTING 1 ,000 GALLON CONCRETE SEPTIC TANK PIPES TO BE LAID LEVEL. BIODIFFUSERS (PROFILE) THROUGH DIG-SAFE AT LEAST 72 HOURS PRIOR TO COMMENCING WORK ON SITE AT CROSS SECTION VIEW (BY INFILTRATOR SYSTEMS, INC.) 1-888-DIG-SAFE AND ANY OTHER APPLICABLE AGENCIES. REPORT ANY DISCREPANCIES SEPTIC TANK PROFILE rr�� TO THE DESIGN ENGINEER. CONTRACTOR TO VERIFY EXISTING ELEVATION PRIOR DISTRIBUTION BOX DETAIL I L ARC 36HC (#3616 B D) BIODIFFUSERS O D I F F U S E RS (H-LO)TO ANY WORK & NOTIFY ENGINEER IF DIFFERENT. NOT TO SCALE NOT TO SCALE NOT TO SCALE 10. ALL JOINTS WHERE PIPE ENTERS AND EXITS CONC. STRUCTURES SHALL BE MADE WATERTIGHT. 11. NO DETERMINATION HAS BEEN MADE AS TO COMPLIANCE WITH DEEDED OR ZONING TEST PIT DATA REGULATIONS. OWNER/APPLICANT IS TO OBTAIN SUCH DETERMINATION FROM • _ , -- t` PERC NO. 13830 APPROPRIATE AUTHORITY. INSPECTOR: Donald Desmarais, IRS 12. ALL SEPTIC SYSTEM COMPONENTS SHALL WITHSTAND H-10 LOADING UNLESS MAP 252 ' � � � EVALUATOR: Michael Pimentel, EIT, CSE LOCATED UNDER PAVEMENT, DRIVES OR TRAVELED WAYS IN WHICH CASE LOT 63 ha C.S.E. APPROVAL DATE: Oct. 1999 THEY SHALL WITHSTAND H-20 LOADING. ' � ! N81°53'10"W �� , I DATE: 13. DOUBLE WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. December 19, 2012 74.36' MAP 252 • � �� TEST PIT#: 1 14. WHERE REQUIRED, CONTRACTOR SHALL REMOVE ALL LOAM, SUBSOIL AND UNSUITABLE LOT 62 ELEV TOP 73.30' MATERIAL IN AREA BENEATH AND FOR 5 FT. ON ALL SIDES OF LEACHING FACILITY. = REPLACE ALL UNSUITABLE MATERIAL.WITH CLEAN COARSE SAND FREE FROM CLAY, FENCE(Tj P.) X X x X X 1 ELEV WATER= <63.30' FINES OR OTHER UNSUITABLE MATERIAL IN ACCORDANCE WITH 310 CMR 15.255(3). �� x • • 'w PERC RATE - <2 min./inch 15. CONTRACTOR SHALL NOTIFY DESIGN ENGINEER OF ANY DISCREPANCIES FOUND IN / / SITE CONDITIONS FROM THOSE SHOWN PRIOR TO CONTINUATION OF WORK. • DEPTH OF PERC= 36"-54" 16. PROPOSED PROJECT IS LOCATED WITHIN: / • • ZONE eberry 2 x� •� •• ) TEXTURAL CLASS: 1 ASSESSOR'S MAP 252 PARCEL 64 J MAP 252 I 3 nd f u �� •. , f / t/ . OWNER OF RECORD: ESTATE OF LILLIAN E. JONES \ LOT 64 "j \ 0 7,790 S.F. ± • ' • ; J , '•:i 0" 73.30' c/o JAMES C. JONES v� A / X , • . . ; jl�c tl IN • * Fill ADDRESS: 24 MIDWAY DRIVE \, '`°' x �� •• . •• ,j��,' (� c`�rI ' • 12" 72.30' CENTERVILLE, MA 02632 l j / X . • * •• LO v v v A/E Loamy Sand FEMA FLOOD ZONE C ��' / • a • ' • 10Yr 3/2 COMMUNITY PANEL# 250001 0005 C a ^M x Q? !I 14" 72.13' #24 x f• • + • C 17. DEED REFERENCES: coEXISTING l X • • • . . �.ff • • Loamy Sand 1.)COURT DOCKET No. BA12P1476EA ;0,_ W I �� I 3-BEDROOM �,\ - EXISTING 1,000 GALLON • • • !1 ' B 10Yr 5/6 2.)DEED BOOK 26662, PAGE 187 DWELLING -l- mil.- j SEPTIC TANK TO BE a + • • " • • • • 36" 70.30' 18. a ' \ I w� TOF 75.5'± 0 i UTILIZED IN THIS DESIGN • , , PLAN REFERENCE: PLAN BOOK 147, PAGE 73 Q W Q „ . • . Perc a • • _ • Q o I C9 a m • I f + • • .; +� ' • • 54" 6g 8�' 19. ALL DISTURBED AREAS SHALL BE RESTORED TO ORIGINAL CONDITION. Lij 20. THIS PLAN IS TO BE USED ONLY FOR SEPTIC SYSTEM UPGRADE. JC ENGINEERING WILL WA� i ' ° • ; NOT ASSUME ANY LIABILITY FOR USES OF THIS PLAN OTHER THAN ITS INTENDED PURPOSE. 3 v B N x • - C Medium -Coarse Sand 21. IN ACCORDANCE WITH 310 CMR 15.401 -15.405, THE FOLLOWING LOCAL UPGRADE Lu 2.5Y 6/6 ) o I (loose) APPROVAL IS REQUESTED FROM 310 CMR 15.211: o 00 1.) A 10.0'WAIVER(10.0'-0.0') FOR THE SETBACK FROM THE PROPOSED LEACHING SYSTEM CHIM o oX LOCUS PLAN TO THE SOUTH PROPERTY LINE. MAP 252 SCALE: 1" = 1000' 0/H LOT 65 /w WALK �, / 120" 63.30' W _---- / 1 U.P.#2 0I"IW ❑/"� `- / No Mottling, Standing or Weeping Observed g/, DR/ 1� DECK DESIGN DATA TEST PIT DATA LEGEND o V EwAY ' j PERC NO. 13830 INSPECTOR: Donald Desmarais, IRSIcy GARAGE X NUMBER OF BEDROOMS (DESIGN) 3 EVALUATOR: Michael Pimentel, EIT, CSE S�xC' EXISTING SPOT GRADE C.S.E. APPROVAL DATE: Oct. 1999 50 EXISTING CONTOUR y ( x DESIGN FLOW 110 GAL/DAY/BEDROOM 4- BUSH (TYP) HC-2 » _ I DATE: December 19, 2012 X TOTAL DESIGN FLOW 330 GAUDAY 50 PROPOSED CONTOUR tiX �. r' M .: k - TEST PIT#: 2 O 1 HC-1 X DESIGN FLOW X 200 % - 660 GAUDAY ELEV TOP = 73.30' ❑/H/W - EXISTING OVERHEAD UTILITIES TP 1' J USE EXISTING 1,000 GALLON SEPTIC TANK \ _P �, (4 73x3 TP 2 SHED k ELEV WATER= <63.30 73x3' o k GAS - EXISTING GAS LINE PERC RATE = W W-- EXISTING WATER LINE 35.0' X CO O z'O INSTALL 21 - ARC 36HC (#3616BD) BIODIFFUSERS (H-20) DEPTH OF PERC = �\ \ N81 " 1�/ / TEXTURAL CLASS: 1 TEST PIT LOCATION°5310 W �y \� �62.14' ( x EXISTING LEACHING PIT TO BE-73 SYSTEM CAPACITY EXISTING 1,000 GALLON SEPTIC TANK s f9 '�- - ,�� PUMPED AND FILLED WITH CLEAN, 3) _ _ �.-- � \� TYP) ^ � (2 1,,_. k COARSE SAND & ABANDONED (TOTAL L.F. OF BIOS)(4.8 SF/LF)(0.74 GPD/SQ.FT.)=GPD 0" 73.30' TREE ( (105.0')(4.8 SF/LF)(0.74 GAUSQ.FT.)= 373.0 GAL. LEACHING/DAY Fill PROPOSED 4" SOLID SCHEDULE 40 PVC PIPE O \ GAS M ti GAS TOTALS: Loam Sand -� L.P. (TYP? _ 12" 72.30' PROPOSED DISTRIBUTION BOX \ !�� SAS X- _X x Y w w` W- X X _X Xf TOTAL NUMBER OF BIODIFFUSERS: 21 A/E 10Yr 3/2 ® PROPOSED ARC 36HC (#3616BD) H-20 BIODIFFUSER GAS_ � 72.13' O W-� _`` GAS TOTAL NUMBER OF COUPLINGS: 0 14' G _ � TOTAL LEACHING AREA: 504.0 PROPOSED INSPECTION PORT W--- - 72 B Loamy Sand ` yam _ TOTAL LEACHING CAPACITY: 373.0 10Yr 5/6 REV. DATE BY APP'D. DESCRIPTION WITH ACCESS BOX(TYP OF 2) APPROX LOCH - �- oy ATIO`� -- V, 36" 70.30' PROPOSED SEPTIC SYSTEM UPGRADE PROP. TOTAL 21 ARC 36HC NOTE: (#3616BD) H-20 BIODIFFUSERS Benchmark PROPOSED DISTRIBUTION BOX PREPARED FOR: \ Nail Set in Oak Tree EFFECTIVE LEACHING AREA OF 4.80 SF/LF OBTAINED FROM THE IN A FIELD CONFIGURATION "` O Elev. = 73.80' DEPARTMENT OF ENVIRONMENTAL PROTECTION APPROVAL LETTER JC1HN L. ` JAMES C. JONES ti "MODIFIED APPROVAL FOR GENERAL USE" ISSUED TO INFILTRATOR Medium -Coarse Sand HIi_!JR. �. Approximate MSL C CH-�" SYSTEMS, INC., DATE OF ISSUANCE OCTOBER 3, 2003 (LAST MODIFIED 2.5Y 6/6 .4 066 MIDWAY DRIVE MARCH 14, 2012). TRANSMITTAL NUMBER=X235253. (loose) s a LOCATED AT u.P. E ' - G/H/v (40'WIDE LAYOUT) 24 MIDWAY DRIVE °'"'W CENTERVILLE, MA 02632 /"/W -- NOTES: `- Gi"/w 120" 63.30' � tA,t,t SCALE: 1 INCH = 10 FT. DATE: DECEMBER 27, 2012 SWING-TIES }� ' F 0 5 10 20 40 FEET 1. MAGNETIC MARKING TAPE SHALL BE PLACED ALONG THE TOP EDGE OF EACH SEPTIC ��/ �, No Mottling, Standing or Weeping Observedy�I SYSTEM COMPONENT. ,� - HC-1 HC-2 RESERVED FOR BOARD OF HEALTH USE N L. `�t�, PREPARED BY: DESCRIPTION ------- JOH 2.) CONTRACTOR SHALL VERIFY SOIL CONDITIONS IN THE LOCATION OF THE PROPOSED BIODIFFUSER CORNER(1) 16.1' 36.9' IVILL JR. « JC ENGINEERING, INC. LEACHING FACILITY TO ENSURE CONSISTENCY WITH TEST PIT DATA SHOWN ON THIS 807 2854 CRANBERRY HIGHWAY PLAN. REPORT TO ENGINEER AND LOCAL BOARD OF HEALTH IF SOILS ARE NOT BIODIFFUSER CORNER(2) 22.5' 40.6' CONSISTENT WITH TEST PIT DATA. ��"'` ' ,c Tt?. EAST WAREHAM, MA 02538 SITE PLAN BIODIFFUSER CORNER(3) 29.0' 20.8' T 508.273 0377 3.) PROPERTY IS LOCATED WITHIN THE GROUNDWATER PROTECTION OVERLAY DISTRICT - ---- --- AND THE ESTUARINE WATERSHEDS. SCALE: 1" = 10' BIODIFFUSER CORNER(4) 24.4' 12.1' Drawn By: DDS Designed By:MCP Checked By:JLC JOB No.2359