Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0053 MIDWAY DRIVE - Health
53 Midwa )•Drive z �,ri� r ,y t �'•` A=252 Hyannis TOWN OF BARNSTABLE LOCATION SS h1 W ,O SEWAGE VILLAGE ASSESSOR'S MAP&PARCEL 2 Z INSTALLER'S NAME&PHONE NO. 1 C. � J£,,I 72610 i{ SEPTIC TANK CAPACITY I t� LEACHING FACILITY: (type) <00 C71 (size) NO. OF BEDROOMS OWNER in id CeVQtt 2 a — PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet .. I Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ELI� q2'Z-� / bh�,,' ��e$ a� No. . ( _ Fee V THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftplitation for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade(Ve/Abandon( ) Complete System ❑Individual Components Location Address or Lot No. ���-j��, .i �/ �� Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ` ` '".�" �e7 v,/1-4 Installer's Name,Address, d Tel.No. Designer's Name,Address,and Tel.No. S dp_ Type of Bquildg: rk 5V T,jS' PD.b*1 11'V wS��^it\S Q �?76 Dwelling No.of Bedrooms Lot Size 6"� O ems' sq.ft. Garbage Grinder( ) Other Type of Building "Z/Osl F No.of Persons Showers( ) Cafeteria( ) Other Fixtures 3 Design Flow(min.re uired) 3 3^ gpd Design flow provided 33 %= gpd Plan Date `f 2-A 41 Number of sheets Revision Date —r�—T Title Se/aT/C C,0AbE [ArA2v br, Cely Cs�t�� Size of Septic Tank Type of S.A.S. Description of Soil .�®i� /S 33 a %�s�r� Z�� /7 Nature of Repairs or Alterations(Answer when applicable) Date last inspected: !/NKti[©WA✓ 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 t E ' enta and:not a the system in operation until a Certific to of Compliance has been issued by this Board of alth. Signed Date Application Approved by Date .t Application Disapproved by Date for the following reasons Permit No. '-6 f 7 2—O0 Date Issued fy.:rir3;::.-�.., _r..f, d. •�,.,�.,�,..�,.,,,.RE��,.9'�.�.,,.,,A,y .`:' "`"-a,.r.+rx i'w*�.-*-,•,-e*r. k 7:�.�4 '"-",,�: ,.':�7pN}r^^•,�:":�s„"^y..`',ir'%`-'fit R__it ' �t•y`.;''k`�j'tY-�"'-�.�a. ..c,,.. No. � � 7 Fee t :THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Disposal �&pstrm (Conetruction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade ZAbandon( ,) Complete System ❑Individual Components Location Address or Lot No.., 35 /���b,ip �/ �C Owner's Name,Address,and Tel.No. Assessor's Map/Parcel ) „ r"y Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No. Type of Buil ing: re it if#ZN 5 ``�PU.NX I I N;w g\on a I'76_165 y .� q �� Dwelling No.of Bedrooms Lot Size ODD sq.ft. Garbage Grinder( ) d s Other Type of Building 4VOv�r�A &` No.of Persons .� Showers( ) Cafeteria( ) Other Fixtures -3 !�i &0 Design Flow(min.XAh,7 ired) .3 3'V gpd Design flow provided 130 gpd Plan Date yNumber of sheets Revision Date Title /-l7%C W 64-4z e -0 S3 A X,Aari-,br. C^,-)le.,Al Size of Septic Tank n Type of S.A.S. Description of Soil .5; � O! 4/e 1, Nature of Repairs or Alterations(Answer when applicable) Date last inspected: !/NkAt 0 wA✓ 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 Erryui nmeng1',Code and not opal lice the system in operation until a Certificate of •14Compliafice havbeen issued by this Board of ealth. r A-2 Signed Date t_/ PIP Application Approved by h Date ro v Application Disapproved by Date for theIfollbwing reasons ,r'1 Permit No. ( off Date Issued (o 1/ -7 THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( �y Upgraded( ) Abandoned( )by at /�^ t/ has been constructed in accorance with the provisions of Title 5 and the for Disposal System Construction Permit No. ;) O/7 -1�� dated /16 /-7 Installer. E(Z-N C C)Ts-j ) Designer / #bedrooms 3 Approved designRflow ^�- ?,,0, gpd The issuance of this permit shall not be construed as a guarantee that the system will functi�o as desigrred. ,,--' " Date Ck'Y 16 Inspector - 11 ---------------------------------------------------- No. cJ d J ! "' O ri Fee GU Q THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS )Disposal 6pstem (Construction permit Permission is hereby granted to Construct( ) Repair(c..)� Upgrade( ) Abandon( ) System located at r i and as described in the above Application for Disposal System Construct ori-Peirinit.-The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completedwithin three,years of the date of this permit: Date (^ Approved by u Town of Barnstable °�"'E nD"Ytio Regulatory Services Richard V. Scali,Interim Director snrwsrnerz Public Health Division 'OIFDMPtA Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 c Installer&Designer Certification Form Date: � � Sewage Permit# Assessor's Map�Parcel �''��" (� Designer: t VtY�u'Q�`'�_ �� Installer: Address: �� V d ( Address: On '0 �p - E�1( was issued a permit to install a ( ate) (installer) septic system at 04 t Jry!!�ll e*k A based on a design drawn by (addr ss) dated A+ ��C (design4l I certify`that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (iTrequired)was inspected and the soils were found satisfactory. I certify that the system referenced above was construct e with the to s of the RA approval letters(if applicable) st is Signature (Designer's Signature) (Affix Desiggner 'g amp Here) PLEASE RETURN TO BARNST E PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc - n Town of BL-'nstable. P# � rq � Department oLRegulatoryServices (j ' Public Health)Division Dace t6TP eKAM $ 200 Main Street.Hyannis MA 02601 Fee Pd. Date Scheduled 1J/a1``T 1 Time G i Moil Suitability Assesstient for S e,disposal/ Performed By. f e^ e' Witnessed By: a LOCATION&GENERAL INFORMATION I.Pcation Address fn A�� ��L v. Owner s Name C��l, (JL'; rLl 1 p, Addmss Assessor's Map/Psircel: �(�7 1� f Engineer's Name NEW CONSTRUftON AU / j/ Tel ephone# Y✓)g 36, f ✓ t Land Use (�£1J (^v Scopes(96) '0 +>/`/ Surface Stones Distances from: Open Water Body ft Possible Wet Areas�b f[ Drinking Water Well �[ i Drainage Way �Zoo ft Property line LQ f[ Other -fit ' SKETCH:(street name,dimensions'of lot,exact locations of test holes&pert tests.locate wetlands in proximity to holes) sull i tt► • j ` � � n Parent material(geologic) i(1C.1 Depth to Bedrock Depth to Groundwater Standing Water in Hole t s i Weeping from Pit Face Estimated SeasonalVgh Groundwater N T)t� E RMINATION FOR SEASONAL HIGH WATER TOLE Method Used: — '�"�'� Depth db�aved standing;tn obs.hole: in. Depth to anti mottles; in. Depth toiweeping from side of obs.hole: in. Oroundwatcr Adjustment D • _ AdJ,factor,..._..,,..AdJ,C=ndwater Love' Index Wcll# Reading Date: Index Well Ievcl -- , ' PERCOLATX°ON TEST . Data T4W Observation j Tune at 9" Hole# 3Q Time at G' Depth of Pere .'rime(9"-61 Slant Pre=soak Time.@ End Pre-soak Rate MinJlneti' •= y (1\: ,i ., + - ' Site Suitability AssessmenC Site Passed Site Failed: Additional Testing Needed(YIN) Originnt:,Pebtie Hehith Division Observation Hole Data To Be Completed on Back---- . ***If percolaOn testis to be conducted witbin 100'of wetland,you must first notify the Barnstable C44servation Division at least one(1)week prior to beginning. DEEP OBSERVATION BOLE LOG Hole# r Depth from Soil Horizon Soil Texture Soil Color Soil Other '} Surface(in.) (USDA), (Munsel0 Mottling (Structure,Stones,Boulders. Consistency,%Graver 1ii T /K DEEP OBSERVATION HOLE LOG Hole# Depth from - Soil Horizon Soil Texture Soil Color Scil Other Surface(in.) (USDA) (Munsel0 Mottling (Structure,Stones,Boulders. 0c %Gravel) O 444•.1. t? 1 DEEP OBSERVATION HOLE LOG Hole# tj Depth fawn' Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munselp Mottling (Structure,Stones,Boulders. ConsistencX. o Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface tn. (USDA) (Munselp Mottling (Structure,Stones,Boulders. Con i to t Flood Insurance Rate Map: Above 500 year flood boundary Not Yes Within 500 year boundary No / Yes T- Within 100 year flood boundary No_ Yes Depth of Naturally Occurring Pervious Material _ Does at feast four feet of naturally occurring pervious material exist.in all areas observed throughout the area proposed for the soil absorption system? f�ri If not,what is the depth of naturally occurring pervious material? ' F Certitication I certify that on f (date)I have passed the soil evaluator examination approved by the Department f Environmental Protection and that the above analysis was performed by me consistent with the requiredrtrai ' g�expe ise and perience 06scribed,in 3,10 CMR 15,017. Signature 1 Date Q:%SEF rtC\PERCFORM.DOC O r— _r CO ti Postage $ OjHere Certified Fee C3 C3 Retum Receipt Feep (Endorsement Required)Restricted Delivery Fee O (Endorsement Required) rq C3 Total Postage&Fees r-9 Sent To r-I Ana -'e---�c�tc.�ra---------------------- $treat,Apt.No.; rn �,J ```��' prim or PO Box No. 53 r t 1 I to W� ------------------- Cify MA bo2(�L Certified Mail Provides: a A mailing receipt IN A unique Aentifier for your mailpiece o A record of delivery kept by the Postal Service for two years Important Reminders: • Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. n Certified Mail is not available for any class of international mail. n NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return 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 a duplicate return receipt,a USPS®postmark on your Certified Mail receipt is required. 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 Delivery". e If a postmark on the Certified Mail 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 an inquiry.. PS Form 3800,August 2006(Reverse)PSN 7530-02-000-9047, SHE T� Town of Barnstable Barnstabi&; . .�°� Regulatory Services Department ;eftaCft IAMSfABLE. 9� "9. ,0� Public Health Division RFD"" A 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL#7012 1010 0000 2847 8506 March 2, 2017 Ana Cerqueira 53 Midway Drive Hyannis, MA 02601 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 53 Midway Drive, Hyannis, MA was inspected on 02/18/2017 by Trevor Kellett, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails"under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: .• Discharge or po.nding of effluent to the surface of the ground. - 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. 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 Evl\53 Midway Drve Hyannis.doc THE r, Town of Barnstable �fD �,�s Regulatory Services Department Public Health Division 200 Main Street, Hyannis MA"02601 Office: 508-8624644 Richard Scali,Director FAX: 508-790-6304 _ Thomas A.McKean,CHO Feb 6, 2007 -Rev. 5111116 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code.§360-44 and Title V: 310 CMR 15,000) _ An"x"marked in the o is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA Discharge or ponding of effluent to the surface of the ground w ❑ Pumping more than 4 times during the last year not due to clogged or obstructed Pipe ❑Backup of sewage'into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA. ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ Any portion of the SAS, cesspool, or privy,below high groundwater elevation ❑ Any portion.of the cesspool within a.Zone 1 to a public well , ❑ Any portion of a cesspool within 50 feet of a private water supply well with no; acceptable water quality analysis. (This'system passes if the water analysis indicates the well is free from pollution): TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool o Any"conditionally passed systems" (broken cover,relocation of a pipe, relocation of a driveway.due to H-10 components, etc) ❑Leaching pit or cesspool with thigh liquid level, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above-the invert pipe (per Town Code §360-20 h) OTHER ❑ f,.. Repair deadline: Q:\SEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc f 252-D Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Midway Drive " Property Address CERQUEIRA,ANA t" Owner_ Owner's Name informa is required for every GeffERVII 1 F HUAnnis MA 02632 2118/17 page. City/Town state Zip Code Date of Inspection a 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. 'mngoutforms A. General Information SA* d:When filling out forms on the computer, use only the tab 1. Inspector: key to move your cursor-do not Trevor Kellett use the return Name of Inspector key. Septic Inspections Co _ ay Company Name 38 Vacation Lane Company Address West Yarmouth MA 02673 Cityrrown State Zip Code 508-579-5502 S113744 Telephone Number License Number B. Certification ;r I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ❑ Passes - ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 2126/17 Inspectors Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and.copies sent to the-buyer, if-applicable,and the approving authority. —This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ms•3M3 Tide 5 OtGdal tnspedon Fomr Subsidam Sewage Disposal System-Page 1 of 17 �0 ed VS r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is CENTERVILLE MA 02632 2/18/17 required for every page City/Town State Zip Code Date of Inspection B. Certification (cant.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: •. El 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 f i I Commonwealth of Massachusetts . - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2118117 page. CityFrown State Zip Code Date of Inspection B. Certification {cunt.) i- ❑,Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes(cunt): T ❑ 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 Heafth):' broken pipe(s)are replaced '❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed : ❑ Y ❑ N, ❑ ND.(Explain below): ❑ distribution box is leveled or replaced F❑ Y ❑ N ❑ ND{Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a.manner which will protect public health, safety and the environment: Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland.or a salt marsh t5ms•3t13 Tide 5 Offiael trim Forth SL(bwface Sewage Disposed System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form: ,,-' Subsurface Sewage.Disposal System form.-Not for Voluntary Assessments . 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name required for CENTERVILLE MA 02632 2118/17 required for every page_ Cityrrown State Zip Code Date of Inspection B. Certification (cons.) - 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. 4 ❑ 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'/2 day flow t5ins•3113 , Title 5 Official Inspeetlon Forth:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection -Form Subsurface Sewage Disposal System Form--'Not for Voluntary Assessments { 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2118/17 page. City/Town State Zip Code Date of irspmWn B. Certification (cunt.) 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. ❑ Z Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ U 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 N 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. f t . E) Large Systems: To be considered a large system the system must serve a facility with a design flow,of 10,000 gpd to 15,0W 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 ❑ e ❑ 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 t5ms•3n3 Title 5 Oftldal h%spectlon Form Subsurface Seara ge Disposal System-Page 5 of 17 Commonwealth of Massachusetts lugTitle 5 Official Inspection Form - Subsurface Sewage Disposal System Form Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's-Name information is required for every CENTERVILLE MA 02632 2/18/17 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? El ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ElWere 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? t® -❑ Was the site inspected for signs of break out? ® ❑ Were a0 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): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 t5ms•3l13 Title 5 Official Inspedion 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 lop 53 Midway Drive Property Address CERQUEIRA,ANA ' Omer Owner's Name information is required for every CENTERVILLE MA 02632 2118/17 page. City/Town State Zip Code Date of Inspection D. System Information Description: This is a standard title v with a tank(converted Cesspool)and two overflow cesspool and trench Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes 0 No Is laundry on a separate sewage system?(Include laundry system.inspection. ❑ Yes ® No information in this report) Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail Sump pump?, ❑ Yes ® No Last date of occupancy: - current Date Commerciallindustrial 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•3113 Title 5 Ofidal Inspection Form Subsuface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official,,Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments. 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is CENTERVILLE MA 02632 2118/17 required for every page City/Town 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 0 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/Afternative 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 l/A system by system operator under contract - ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): , t5ns•3113- Tiffe 5 Otfidef Inspedion-Faro:Subsumes Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts _• Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-"Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name refo redo is CENTERVILLE MA 02632 2118/17 required for every ' page- City/Town State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed(if known)and source of information: 6-4-85 per plan Were sewage odors detected when arriving-at the site? ❑ Yes 0 No Building Sewer(locate on site plan): Depth below grade: - 2.7 feet Material of construction: ❑cast.iron ®.40 PVC, 0 other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints,venting, evidence of leakage,etc.): Septic Tank(locate on site plan): Depth below grade: 2 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: 1000g Sludge depth: - 8" t5ins•3113 Tile 5 Official inspection Form:Subauface Sewage Disposer System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form = Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2/18117 page, C41'rown State Zip Code Date of Inspection D. System Information (cont.) a , Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 53, Scum thickness 1" Distance from top of scum to top of outlet tee or baffle 4", Distance from bottom of scum to bottom of outlet tee-or baffle 19, How were dimensions determined? measured Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): tank is structurally sound and water tight with liquid an inch above outlet invert, a lot of high staining common with backup, both tees are fine,tank does not need to be pumped e Grease Trap(locate on site plan): Depth below grade: feet Material of construction: n concrete E metal El-fiberglass 0 polyethylene- 0 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•3l13 Tithe 5 Offidal trspedion Fortrc 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 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is E MA 02632 2118/17 required for every CENTERVILL - page. City/Town 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.)-. a 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 worldnq 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•3113 Tide 5 Official Inspection Pomp.Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form, Subsurface Sewage Disposal System Form-Not for.Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVIL LE MA 02632 2118/17 page City/Town 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 N/A 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.): No Box Pump Chamber(locate on site plan)- Pumps in working order. ❑ Yes ❑ Not Alarms in working order. ❑ Yes• ❑ Not Comments(note condition of pump chamber,condition of pumps and appurtenances, etc.): t If pumps or alarms are not in working order,system is a conditional pass. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located,explain why: t5vrs•3113 Tithe 5 Of6da1 U�ection Form SL&safaoe Semp Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form' Subsurface Sewage Disposal System Form'-Not for Voluntary Assessments, 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2118/17 page- CityrTown State Zip Code Date of Inspection D. System Information (cost.) Type: ❑ leaching pits number. Q leaching chambers number. ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields nunber, dimension . ® overflow cesspool number. 2 ❑ innovative/alternative system Type/name of technology. Comments(note condition of soilisigns of hydraulic failure, level of ponding, damp soil,condition of vegetation, etc.): There are 2 overflow cesspools for this system the first in line is down TZ'the water was above both the inlet and outlet at time of inspection,the second pool was down 2'6'with a riser at 10", also has a trench rtmnin off of it the soil above the second pool was soaked and smelled of effluence Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration 3 inline 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 t5in5.3113 ride 5 OfBoal evspedan Form Subwfece Sewage Disposal systen•rage 13 of 17 . Commonwealth of Massachusetts fi Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2118/17 page Cityrroinm State Zip Code Date of Inspection D. System Information (cons) _ 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.): t5ms•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form_Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Corner Owner's Name information isCENTERVILLE MA 02632 2/18/17 required for every page, City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building.Check one of the boxes below. ® hand-sketch in the area below ❑ drawing attached separately Back of house . , A nB j Deck Patio I 1 I I t :I 2 + 1 I I I I I t I A1)24 r A2)19 I A3)18.5 I A4)39 3 I t B1)13 . . . . . . . . . . . . . i B2)14 B3)20 j B4)38 t • t t E s f t5ins•3113 We 5 0tfidal Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System form-Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is CENTERVILLE MA 02632 2118/17 required for every page City/Town State Zip Code Date of Inspection D. System Information (cont.) , Site Exam: ® Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells depth to high round water. feet Estimated de P 9 9 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 El Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: 0 Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: You must describe how you established the high ground water elevation: USGS Maps show GW at 70 ft Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5ins•3113 Title 5 Official Uispection Forth Subsurface Sewege Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form NWe Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 53 Midway Drive Property Address CERQUEIRA,ANA Owner Owner's Name information is required for every CENTERVILLE MA 02632 2118/17 3age City/Town 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 t5im•3n3 Title 5 Official Inspection Form SLbsuface Sewage Disposal System•Page 17 of iP co Ln Lf)Ln /• I • �, ••• ro = 0 >£ ;f: tY `: A tam '$x>.^, '+ffia:s: F&::rx Ln Postage p Certified Fee p / Postmark p Return Reciept Fee (Hg�g eO6c (Endorsement Required) FEB J � Restricted Delivery Fee (Endorsement Required) ..0 Total Postage&Fees V$ S m p S t To C3 S rest, f. D or PO Box No. City,State +4 ,30-L- Certified Mail Provides' - (asianay)ZOOZ eunp'OOae Wiad Sd o A mailing receipt o A unique identifier for your mailpiece a A record of delivery kept by the Postal Service for two years Important Reminders: e Certified Mail may ONLY be combined with First-Class Maile or Priority Maile. o Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return 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 a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. e 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 Delivery". e If a postmark on the Certified Mail 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 an inquiry. Internet access to delivery information is not available on mail addressed to APOs and FPOs. COMPLETE •N COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Sig ature item 4 if Restricted Delivery is desired. - X 1 ❑Agent ■ Print your name and address on the reverse 1. ❑Addressee so that we can return the card to you. B, ceiv d by(Pinted Name) C. Date f Delivery ■ Attach this card to the back of the mailpiece, ( or on the front if space permits. ftil 0 5 t W� � �6 �yu ,D, Is delivery address different from item t? ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No q LER 0-46Rza 3. ,Service Type m fhYq�Certified Mail ❑ Express Mail 0 ❑ Registered ❑ Return Receipt for Merchandise ❑ Insured Mail ❑ C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number (Transfer from service label) ; 7 0,0 3 -16 8;0 0004 545 8 3558 . PS Form 3811,August 2001 , Domestic Return Receipt ' 102595•02-M-1540 UNITED STATES POSTAL$ER `G, First-Gass-Mail Postage&Fees Paid USPS, Permit No.G-10 • Sender: Please pant%goLES rAlme, address, an�Z1�+4 in this 4ox—t—, � 4zq L'(-h ��vis�� s-'k9� � 9 t,C>Clri, 1�liFilf�i�iSlii �lt1114 �i -iil4�li!�4!!il?.1i�1f1l1Ii31ff1Pi� oFTHE r Town of Barnstable ti Department of Health Safety,ty, and Environmental Services • BARNSTABLE, 9 MASS. $ Public Health Division i639• ♦0 _ 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health Ana Cerqueira Swila February 9, 2006 P.O. Box 402 Centerville, MA.,02632 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000 STATE ENVIRONMENTAL CODE. TITLE 5 The property owned by you located at 53 Midway Drive, Centerville, MA. was inspected on February 8, 2006 by Donald Desmarais RS, Health Inspector for the Town of Barnstable, because of a complaint regarding overcrowding. The following is a violation of 310 CMR 15.000 State Environmental Code, Title 5. 310 CMR 15.00. There were two (2) bedrooms located in the basement of the residence, along with a bedroom in a converted garage. A Title V inspection was done on this property on 6/20/2001. That inspection showed the design of the septic system to have the capacity for three bedrooms. In addition, the home is located in a Zone 2 (ground water protection area) and is allowed only the three bedrooms it was originally constructed with, no more. You are ordered to remove the two bedrooms located in the basement and the bedroom in the garage on or before Monday March 10, 2006. A re-inspection is scheduled to be held on Monday, March 13 2006 at 10:00 a.m. You may request a hearing before the Board of Health if written petition requesting it is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE OARD OF HEALTH s A. McKean Director of Public Health F 1NE T o Town of Barnstable Department of Health, Safety, and Environmental Services Public Health Division rEc►��°i . 367 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas A.McKean FAX: 508-790-6304 Director of Public Health Ana Cerqueira Swila February 9, 2006 P.O. Box 402 Centerville, MA. 02632 NOTICE TO ABATE VIOLATIONS OF 310 CMR 15.000 STATE ENVIRONMENTAL CODE, TITLE 5 The property owned by you located at 53 Midway Drive, Centerville, MA. was inspected on February 8, 2006 by Donald Desmarais RS, Health Inspector for the Town of Barnstable, because of a complaint regarding overcrowding. The following is a violation of 310 CMR 15.000 State Environmental Code, Title 5. 310 CMR 15.00. There were two (2) bedrooms located in the basement of the residence, along with a bedroom in a converted garage. A Title V inspection was done on this property on 6/20/2001. That inspection showed the design of the septic system to have the capacity for three bedrooms. In addition, the home is located in a Zone 2 (ground water protection area) and is allowed only the three bedrooms it was originally constructed with, no more. You are ordered to remove the two bedrooms located in the basement and the bedroom in the garage on or before Monday March 10, 2006. A re-inspection is scheduled to be held on Monday, March 13 2006 at 10:00 a.m. You may request a hearing before the Board of Health if written petition requesting it is received within seven (7) days after the date the order is served. Non-compliance could result in a fine of up to $100.00. Each day's failure to comply with an order shall constitute a separate violation. PER ORDER OF THE OARD OF HEALTH s A. McKean Director of Public Health oFTr+e r Town.of Barnstable o Regulatory Services Thomas F. Geiler,Director * enaNsrnaLE, 9 Mnss. Building Division �'°rFn�erA`0 Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 February 14, 2006 Ana Cerqueira PO Box 402 Centerville, Ma 02632 Re: Illegal Apartment Property ID: Map 252 Parcel 079 Locus: 5YMidway Drive,,Hyannis Dear Ms. Cerqueira: A review of our records, including the permitting history and the Zoning Board of Appeals records, indicates that the present use of your property located at 53 Midway Drive is limited to that of a single-family home; any other use, specifically an independent accessory dwelling unit is illegal. You are hereby ordered to immediately restore the subject property to a single-family residence containing only three bedrooms. A building permit is required in order to reconfigure the space and convert the property to its original state. This work shall be completed by March 1, 2006. You will notify this office accordingly and subsequently arrange for a site inspection to confirm the restoration. I am also compelled to advise you that there is an appeal process available to you. We will be happy to assist you if you choose to explore this option, although it is my understanding from Health Inspector Donald Desmarais that you have agreed to take immediate action to remove the illegal bedrooms. I must reiterate that a building permit is necessary for this work in order to not only document your cooperation but to record the resulting status of the property. Please contact me at 508-862-4027 by February 24, 2006 in order to establish your intent. Sincerely, Robin C. Giangregorio Zoning Enforcement Officer JAIllegal Apartments\53 Midway Dr Cerqueira.DOC s �f o O 1 f 6� h f c� O S o d It Qs Jz— CIS � o ~t o � t o II fb n i - 1 ' !fi } A. r + } 4qn. f4. yAl. , f 1 rr,,, e•��d�•r, m `'�:. 'fit` - V v r ° 'ai s ti x` fit.. � �•. ' a E'E'8's F ! Pvi �1�i AX cia p , 'Ira Q a t-YRpr kv x74744} < t. 4 g s x f a E' t r rt I II x � s r� r t t. l nE x � `f c 4 ZU ZfF . if _ a , r V -z 'w w` E y, r� w r d� tea . 44 p � 4 �F,a ✓ - r.c. a as "b j r; n i A ., a a,. a �• � vP rA - '° _ .� a yy _ a e g i ♦ �y -�. n } i h x `- ,. .' �. T � _• a ., .. :S: - nUt sRRayS � �Y r 3 aL 4 C 5 r r y v AM yl, MEN wwri aIN ' i t SETTS COMMONWEALTH OF MENVIRONMENTAL AFFAIRS EXECUTIVE OFFICE OF ENVI DEPARTMENT OF ENVIRONMENTAL PROTECTION M - d � d F A Y ��M Sew TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNT ORMESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM PART A CERTIFICATION Property Address: 53 MIDWAY DR CENTERVILLE, MA 02632 Owner's Name:. BRUCE BOTELHO Owner's Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Date of Inspection: 6/20/01 ector: (please print) JOHN GRACI Name of Insp SEPTIC INSPECTIONS Company Name: P.O. BOX 2119 TEATICKET,MA.02536 Mailing Address: Telephone Number: 508-564-6813 FAX 508-564-7270 CERTIFICATION STATEMENT based on my training and inspected the sewage disposal system at this address fo mtedt the information reported below is I certify that I have personally mspe roved system true,accurate and complete as of the time of the inspection.The inspection was per in the roper function and maintenance of on sitRs15.000).ewage 'The systemms. 1 am a DEP app experience P inspector pursuant to Section 1.5.340 of Title 5(310 C X Passes _ Conditionally Passes the Local Approving Authority _ Needs Furthe valuation by _ Fails Date: 6/20/01 Inspector's Signature: l� within Approving Authority(Board of Health or DEP) The system inspector shall submit a opy of this inspection report to the App g d or greater,the the a ropriate regional office of the DEP.The original should be f completing this inspection. If the system is a shared system or has a design flow of I0,0 gp 30 days o p proving authority. inspector and the system owner shall submit the report f and the app g sent to the system owner and copies sent to the buyer, if applicable, Notes and Comments RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG SYSTEM PASSES TITLE V IN •.' THE SYSTEM'S USEFULL LIFE. e same or different conditions of,use.` ****This report only describes condi tions 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 futurr under t p t Page 2;of I 1 S OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 53 MIDWAY DR CENTERVILLE, MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: X 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: SYSTEM PASSES TITLE V INSPECTION.RECOMMEND PUMPING SYSTEM EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE. B. System Conditionally Passes: _ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND) in the for the following statements. If"not determined" please explain. n/a 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►eaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: n/a n/a Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced _ obstruction is removed _ distribution box is leveled or replaced ND explain: n/a n/a The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken.pipe(s)are replaced _obstruction is removed . ND ezplaiii' ida 'x, Page 3 of 1 1 OFFICIAL INSPECTION FORM -NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 C. Further Evaluation is Required by the Board of Health: _ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment., 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is, not functioning in a manner which will protect public health,safety and the environment: _ Cesspool or privy is within 50 feet of.a surface water _ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 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 I 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 n/a "This system passes if the we1'1 water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: n/a Page 4 of 1 1 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each.of the following for all-inspections: Yes No X Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool X Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ' _ X Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool X Liquid depth in cesspool is less than 6"below invert or available volume is less than %day flow X Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped nLa. _ X Any portion of the SAS,cesspool or privy is below high ground water elevation. X Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ X Any portion of a cesspool or privy is within a Zone 1 of a public well. X Any portion of a cesspool or privy is within 50 feet of a private water supply well. _ X Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from thai facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.) (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.'The`sy§tem owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no X the system is within 400 feet of a surface drinking water supply X the system is within 200 feet of a tributary to a surface drinking water supply X the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area— I WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes" in Section D above the large sysiem has filed, The owner or operator of any large system considered a significant thrm under Section E or failed under Sectionb sliall upgrade the system in accordance with 310 CMR 15,304. The system owner should contact the appropriate regional office of the Department. -._. J ` Page S of I I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 53 MIDWAY DR CENTERVILLE, MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 Check if the following have been done. You must indicate "yes" or"no" as to each of the following: Yes No X _ Pumping information was provided by the owner,occupant,or Board of Health _ X Were any of the system components pumped out in the previous two weeks'? X _ Has the system received normal flows in the previous two week period X Have large volumes of water been introduced to the system recently or as part of this inspection '? _ X Were as built plans of the system obtained and examined?(If they were not available note as N/A) X _ Was the facility or dwelling inspected.for signs of sewage back up'? X _ Was the site inspected for signs of break out? X _ Were all system components, excluding the SAS, located on site" X _ Were the septic tank manholes uncovered,opened, and the interior of the tank inspected for the condition of the baffles or tees,material of construction,dimensions,depth of liquid,depth of sludge and depth of scum ? X _ Was the facility owner(and occupants if different from owner)provided Nvith information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no _ X Existing information. For example,a plan at the Board of Health. X _ Determined in the field(if anyof the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(3)(b)] , a I ,Page 6 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 53 MIDWAY DR CENTERVILLE, MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 .Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 2 Does residence have a garbage grinder(yes or no): NO Is laundry on a separate sewage system(yes or no): NO [if yes separate inspection required] Laundry system inspected(yes or no): NO Seasonal use: (yes or no): NO Water meter readings, if available(last 2 years usage(gpd)): n/a Sump pump(yes or no): NO Last date of occupancy: n/a COMMERCIAL/INDUSTRIAL Type of establishment: n/a Design flow(based on 310 CM 15.203): n/agpd Basis of design flow(seats/persons/sgft,etc.): n/a Grease trap present(yes or no): NO Industrial waste holding tank present(yes or no): NO Non-sanitary waste discharged to the Title 5 system(yes or no): NO Water meter readings, if available: n/a Last date of occupancy/use: n/a OTHER(describe): n/a , GENERAL INFORMATION Pumping Records I C�(`l�`�e� Source of information- S 1 I `C'� �au Was system pumped as part of the inspection(yes or no): NO If yes, volume pumped: n/agallons-- How was quantity pumped determined? n/a Reason for pumping: n/a TYPE OF SYSTEM X Septic tank,distribution box,soil absorption system _Single cesspool _Overflow cesspool _Privy Shared system(yes or no)(if yes, attach previous inspection records, if any) _Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) _Tight tank Attach a copy of the DEP approval Other(describe): n/a i tApproximate age of all components, date'installed(if known)and source of information: 30 YEARS Were sewage odors detected when arriving at the site(yes or no): NO Page 7 of I I , A OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 BUILDING SEWER(locate on site plan) Depth below grade:30" Materials of construction:_cast iron _40 PVC Xother(explain): ORANGEBURG Distance from private water supply well or suction line: n/a Comments(on condition of joints,venting,evidence of leakage,etc.): TOWN WATER SEPTIC TANK: X(locate on site plan) Depth below grade: 24" t Material of construction: Xconcrete_metal fiberglass_polyethylene other(explain)n/a If tank is metal list age: n/a Is age�.confirmed by a Certificate of Compliance(yes or no): NO(attach a copy of certificate) Dimensions: 6' X 6' BLOCK CESSPOOL" Sludge depth: 1" Distance from top of sludge to bottom of outlet tee or baffle: 33" Scum thickness: 1" 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: n/a How were dimensions determined: MEASURED Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): THE MAIN CESSPOOL AND ALL COMPONENTS ARE STRUCTURALLY SOUND AND FUNCTIONING PROPERLY. RECOMMEND PUMPING EVERY TWO YEARS TO PROLONG THE SYSTEM'S USEFULL LIFE SYSTEM GREASE TRAP:_(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Scum thickness: n/a Distance from top of scum to top of outlet tee or baffle: n/a Distance from bottom of scum to bottom of outlet tee or baffle: n/a Date of last pumping: n/a Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc:): n/a Page 8,of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 TIGHT or HOLDING TANK: (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: n/a Material of construction:_concrete_metal_fiberglass_polyethylene_other(explain): n/a Dimensions: n/a Capacity: n/a gallons Design Flow: n/a gallons/day Alarm present(yes or no): N/A Alarm level: N/A Alarm in working order(yes or no): NO Date of last pumping: n/a Comments(condition of alarm and float switches,etc.): n/a F. DISTRIBUTION BOX: _(if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: n/a 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 or no): NO Alarms in working order(yes or no):NO Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): n/a R Page q of 1 I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 MIDWAY DR CENTERVILLE, MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 SOIL ABSORPTION SYSTEM(SAS): X (locate on site plan,excavation not required) If SAS not located explain why: n/a Type 1000 GAL 6' X 6' leaching pits, number: 1 n/a leaching chambers, number: n/a n/a leaching galleries, number: n/a I leaching trenches, number, length: 20 n/a leaching fields, number: n/a 6' X 6' BLOCK CESSPOOL overflow cesspool, number: 1 n/a innovative/alternative system Type/name of technology: n/a Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil,condition of vegetation,etc.): THE LEACH P115AND OTHER COMPONENTS APPEAR TO BE FUNCTIONING PROPERLY.THE PIT3SHOW NO SIGNS OF HYDRAULIC FAILURE. SYSTEM COMPOSED OF 6 X 6 CESSPOOL-OVERFLOW CESSPOOL AND 20 FOOT TRENCH CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: n/a Depth—top of liquid to inlet invert: n/a Depth of solids layer: n/a Depth of scum layer: n/a Dimensions of cesspool: n/a Materials of construction: n/a Indication of groundwater inflow(yes or no): NO Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a PRIVY: (locate on site plan) Materials of construction: n/a Dimensions: n/a Depth of solids: n/a Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): n/a Page10 of l I OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 53 MIDWAY DR CENTERVILLE,MA 02632 Owner: BRUCE BOTELHO Date of Inspection: 6/20/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two penranent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. 'A P/4 06 OA ACC �4 31 SS Pagel 1 of I I OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 53 MIDWAY-DR CENTERVILLE, MA 02632 Owner: BRUCE BOTELHO y Date of Inspection: 6/20/01 SITE EXAM _Slope _Surface water _Check cellar Shallow wells Estimated depth to ground water 12 feet Please indicate(check)all methods used to determine the high ground water elevation: NO Obtained from system design plans on record- If checked,date of design plan reviewed: n/a NO Observed site(abutting property/observation hole within 150 feet of SAS) NO Checked with local Board of Health-explain: n/a NO Checked with local excavators,-installers-(attach documentation) YES Accessed USGS database-explain: n/a You must describe how you established the high ground water elevation: C TOWN OF BARNSTABLE C LOCATION1 SEWAGE # l j VILLAGE l Y.1A✓"h�1 ASSESSOR'S MAP & LOT IS' INSTALLER'S NAME&PHONE NO. i '— s t SEPTIC TANK CAPACITY A!00 , LEACHING FACILITY: (type) LC., Y 9'O (size) NO. OF BEDROOMS BUILDER OR OWNER r; hCc— r✓ PERMTTDATE: — r 7 COMPLIANCE DATE: U,P-- Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leachin Facility Feet ny w�Ils Private Water Supply Well and Leaching Facility (If a exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetl Xse st within 300 feet of leaching facility) Feet Furnished by c �a i TOWN OF BARNSTABLE LOCATION S -44 Ad G✓ ID41Urc SEWAGE # VILLAGE" n 1-.- An tiSSESSOR'S MAP & LOT INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LEACHING FACILITY: (type) (size) NO. OF BEDROOMS —� 6 BUILDER OR OWNER 4 PERMITDATE: COMPLIANCE DATE: ` Separation Distance Between the: I Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by i n �� � �� I � � t � �' �� � .. $. � -v ��� � � � �� ��� �� �S , �� .� t J r lQ• CATION SEWAGE PERMIT NO. Sa, �l two - S 5� 535 VILLAGE 11 A- INSTALLER'S NAME i ADDRESS s U I L D E R OR OWNER I DATE PERMIT ISSUED DATE COMPLIANCE ISSUED (le gs . I ✓ l 1ldig � . s�oradss�a -F, No.: ......... Fu$..........jS.� . THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ------- -- ----- --------------------OF..........................._............ ............................................. App iratiou for Disposal Works Tonsiruriiuu rrati# Application is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: • - ., _.... ..`.:Q..fN. f `f----iDP� `� --................. -- - -------------------------------------------. Location-Address or Lot No. - . Sl ,,.•....'j12 ..G1...- •-•-•••••-••••-•-•---••-•-•---• .................... !'t't"4. Ow Address aT?. �� ......... ....... g.Y.... ! ' *,,----------------------- Installer Address Type of Building Size Lot............................Sq. feet Dwelling—No. of Bedrooms.___.__...............................................Expansion Attic ( ) Garbage Grinder ( ) '4 Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures .--•••--•--•-•. -•-•---•-•----- - W Design Flow........_..5.. .....................gallons per person per day. Total daily flow.......-Z.3 5:72......_.._............gallons. WSeptic Tank—Liquid capacity..........__gallons Length................ Width................ Diameter................ Depth................ x Disposal Trench—No. .................... Width......._............ Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I---------_---- Diameter.....__......... Depth below inlet...... Total leaching area..................sq. ft. z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed by.......................................................................... Date........................................ aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ (i Test Pit No. 2................minutes per inch Depth of Test Pit--------------- Depth to ground water........................ a -------•--•--•-•---•-•......-•-•-•----•-------•-----•-------------------------------••-••••••-------......................................................... 0 Description of Soil........................................................................................................................................................................ x x ---••------------------------•----•-••-----------••-•---•--•----•--••---•--•---•-----------•-••---•------------•--.....----•-••--•-•---••......•---•-••--•---••--...................................... U Nature of Repairs or Alterations—Answer when applicable.-----1.. .'O.__.._l¢.Q.t ___._ � `.._S. �__-ZA-.xe"t0: ..--------•-------�C---•-..... sS_=s_w•L_7....C_=� &?� ------ { ' ...-................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iITL L 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Co pliance issued by he board of health. r ignd--•---- ----------- ............ •--- � .J_.. Date Application Approved BY . ------•--------------• _ 5 Date Application Disapproved for th f of owing reasons----------------------------•-•-----------------------......---------........................................... ...................................................... ................................................. .......... Date Permit No. 5......... - Issue(L-------------- - ----- ate 1 rZ No..QS._:-.3 5 Fps............._............... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .................................O F.......................................--------------------......__.............--------•- Appliratilan .fir Disp•aiittl Workii Tontitrnsfilin "pami# Application is hereby made for a Permit to Construct ( ) or Repair ( } an Individual Sewage Disposal System at: •• ........ _ ---__-•••---- •r+ f ` Lr rdation Ads or Lot No. - r7 ------------------- ............................................... 7lddress d� RBstaller e '".G7 ii� `�•!e'a ilS.Adds Y ? .... Type of Building Size Lot............................Sq. feet U Dwelling No. of Bedrooms....___ ---------------Ex Expansion Attic Garbage Grinder�+ g— P ( ) g ( ) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) al Other fixtures .......................................................... w Design Flow_____________�_-__,__1--_---•_.............gallons per person per day. Total daily flow.__.._.- .1>.............._......gallons. WSeptic Tank—Liquia capacity............gallons Length................ Width....._.____..__. Diameter._...__._._..... Depth................ x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No......I............. Diameter................ Depth below inlet......i-I.!_...... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) Percolation Test Results Performed bY................................-......................................... Date.......................... ........ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water_____-_______---_.___-_. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ •-----•-•-.--•---•--•---••-•--•-•-------------•------•------••••-------..............._..--•--------........................................................ 0 Description of Soil.........................................................................................................................------------------........................... W U w V Nature of Repairs or Alterations—Answer when applicable..._..�__Q_` -------L4.O_0..... ¢? ...................•- _ _ 1...'�---• 1r/�.;14' ----' _ G'•• {____ •lam. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Co pliance has been issued by,the board of health. ' Signcrens': =" ,; i �-?� �- _ .............. -----�' =" m•.�— .r -.., Date Application Approved BY --- �� ------------ DateJ� Application Disapproved for th f of owing .------•------------------------------------------------------•-----------------------------------.......--=-- ....... .......................... �( Date PermitNo......................................................... Issued.......................................................... ate THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF.................................................................................... Trrtif iratp of (9autpliatire THIS IS TO RT FY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) b "'__Installer at__.._.._.. ���- a� M (} ---------P ---------------------------------------------------------•-----•-_-•._-______---•------------ has been instal in accordance with the provisions of TIT E 5 of The State Sanitary Code ps Oescribed in the application for Disposal Works Construction Permit No--------- dated......_.. Q_ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C06d TRUE® AS A UA EE THAT THE SYSTEM WILL)FU CT ON SATI'bFACTORY. g._ Inspector ----------------- DAT ' ----------------- ............ THE COMMONWEALTH OF MASSACH ETTS BOARD OF HEALTH .............0F.. ` ..... ...0 e.,�a�................................ .. No... FEE-+-1 •51............. Rso w Works Tongion anti 4 `" - Permission is hereby granted...... "' :<�:..- - - .......................................................... to Construct ( ) or Repair ( )_.an Individual Sewage Disposal System atNo........5--- ......lNl_c..!?•!'k'.(9.��--- ''``' -------------------••----- ------ -----------------------•---.........------•.------.......------•----..... Street as shown on the application for Disposal Works Construction Permit N�I......... n__ Dated.._ ?_...4._ __.,� ___._.... K -� �, -•-• •-- . {� �� DATE..... ••---•--•--••-------------------•---•---• oarhw�alth FORM 1255 q. M. /LKIN, INC., BOSTON 4 LEGEND CENTERVILLE PROPOSED CONTOUR ® PROPOSED SPOT GRADE WEQUAQUET EXISTING CONTOUR LAKE + 96.52 EXISTING SPOT .GRADE LOCUS M WA W— EXISTING WATER SERVICE �� 53 MIDWAY D �/ TEST PIT 4 S � DRIVE E of I I SCALE: 1"=20' I? EDGE D R ' / O VEJ PA VEh4CN T UTILITY POLE OF AREA 80.00 WATER GATE 71% __ RTE 28 73 mop, j'i� / LOCUS MAP 73 3 PLAN REF: 315/22 w , TITLE REF: 14100/067 _ LOT 1_ / PARCEL ID: MAP 252 PAR. 079 o AREA = 8000 sf+— p / PLAN B00K 147 PAGE 73 a IN STATE ZONE II /SALTWATER ESTUARY A sR MAP252 PCL 79 > FLOOD ZONE: "X" a / ! COMMUNITY PANEL: 25001CO562J DATED:07/16/14 1 - o EXISTING SEPTIC SYSTEM DWELLING ' REPAIR PLAN LOCATED AT: FLOP OF7FfJGr i 5 53 MIDWAY DRIVE 7,3.49+ — o CENTERVILLE, MA. to 0 PREPARED FOR O CONCRETE ANA CERQUEIRA �r~ PATIO 72 70 ft P - _� APRIL 26, 2017 TP / / _ O HED ����110 110 �Fss9�y PR C50ANK 7 o DARfEFI M. EPTI 1' 0 ft � M �� - 25may, , 11140� Oak MNITOO ' PLAN I SCALE: 1 in = 20 ft BENCH MARK MEYER & SONS, INC. o zo 40 * P.O. BOX 981 PAINT SPOT ON o 10 20 40 CONCRETE PATIO 72. 22 EAST SANDWICH, MA. , 02537 BARNSTABLE CIS DATU PH: (508)360-3311 FAX: (774)413-9468 meyerandsonstitle5-@gmail.corn r SHEET 1 OF 2 1886 ELEV. TOP FOUNDATION NOTE: PLACE MAGNETIC MARKING TAPE OVER ALL COVERS (Existing) BRING ALL COVERS TO WITHIN 3" OF FINISH GRADE FINISHED GRADE (72.20) 73.49 F.G.EL: 72.5 F.G.EL: 72.40 F.G. EL: 48.50 a MAINTAIN 2% MIN SLOPE OVER LEACHING AREA A' .B F.G.EL: 70.70 ;•' ;, 2" OF 3/8" DOUBLE WASHED 3/4" - 1-1/2" .,• . STONE OR FILTER FABRIC DOUBLE WASHED STONE A 6" 4" SCH 40 PVC LLi 10"I 6 (MIN. ®®®®®®®®®®® A' TEE'S ARE TO BE 14 INV.69.1 3 S= 1% ®®®®®®®®®®® 4" SCH 40 PVC 2 EFF. DEPTH ®®®®®®®®®®® I NV.69.38 INV.68.96 4' 2 'X 8.5' 4' GAS 1 ExlsnNc OUTLET BAFFLE PROPOSED DB 3 -ilk ••. .. ..:.. . DISTRIBUTION BOX EFFECTIVE LENGTH = 25' INV. 70.33 INV. 69.63 �m cm Aga (H20) INV. ELEV.= 68.70 PROPOSED 1,500 GALLON SEPTIC TANK - GAS BAFFLE TO BE INSTALLED ON ���'� �F �Ass9 BREAKOUT OUTLET TEE AS MANUFACTURED BY o� D EN M. �yG� ELEV.= 69.70 TUF-TITE, ZABEL, OR EQUAL TOP CONC. ELEV.= 69.70 1 0 N INV. ELEV.= 68.70 E3 ®® NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING ®®®® PIPE INVERTS PRIOR TO CONSTRUCTION O ®®®®®®® �PfI1S1E ®®®®®®® 2) TANK AND D-BOX SHALL BE SET LEVEL AND S41TV0 BOTTOM EL.= 66.70 0=E3UU5=zUUU= TRUE TO GRADE ON A MECHANICALLY COMPACTED 3.75' 5 FT. 3.75' SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN S. 310 CMR 15.221(2) �- v 3) INSTALL INLET & OUTLET TEES W/ SEPARATION 5.40 FT. EFFECTIVE WIDTH = 12.5' GAS BAFFLE AS REQUIRED SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 61 .30 SOIL ABSORPTION SYSTEM (SECTION) (500 GALLON LEACH CHAMBER) GENERAL NOTES: SOIL LOGS P#:15332 DESIGN CRITERIA **NO PROPOSED INCREASE IN FLOW' 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL NUMBER OF BEDROOMS: 3 BEDROOMM DESIGN BOARD OF HEALTH AND THE DESIGN ENGINEER. 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS DATE: APRIL 21, 2017 SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE DESIGN PERCOLATION RATE: <2 MIN/IN LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: SOIL EVALUATOR: DARREN MEYER, R.S., CSE #16,14 - 310 CMR 15.405 (1) (B): WITNESS: DON DESMARAIS, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 3 BR• = DESIGN FLOW: 330 G.P.D. 1) A 1.60 FT. VARIANCE FROM 310CMR15.211 TO ALLOW LEACHING GARBAGE GRINDER: NO (not designed for garbage grinder) TO BE 18.40 FT (MAX) FROM DWELLING VS REO'D 20 FT. SEPTIC TANK: 3. THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR Elev. TP-1 Depth Eler. TP-2 Death 330 gpd x 200% = 660 gpd, USE PROPOSED 1,500 GAL. SEPTIC TANK TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 72.30 0" 72.40 0" DESIGN ENGINEER. FILL FILL (330) = 445.94 S.F. LEACHING AREA REQUIRED: 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING 71.55 9" 71.57 10" .74 FROM THOSE SHOWN HEREON SHALL BE REPORTED TO THE DESIGN A A 0 ENGINEER BEFORE CONSTRUCTION CONTINUES. LOAMY SAND LOAMY SAND 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. tOYR 4/1 10YR 4/1 USE TWO (2) 500 GALLON PRECAST LEACH CHAMBERS W/ 4 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 71.05 B 1s" 70.98 B 17" STONE ON ENDS & 3.75' STONE ON SIDES: 25' L x 12.5' W x 2'D THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. LOAMY 1 55A/P81D LOB SAND BOTTOM AREA 25 x 12.5= 312.5 SF 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. 69.30 C1 36" 69.32 C1 37" SIDE AREA: (25 + 12.5) X 2 X 2 = 150 SF 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED PERC O FINE-MED FINE-MED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. ' EL. 67.80 SAND SAND TOTAL SQUARE FEET PROVIDED = 462 vs. 445.94 REQ'D 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE 67.63 2.5Y 6/4 56" 67.82 2.5Y 6/4 55" DESIGN FLOW PROVIDED: 0.74(462 S.F.) 342.25 G.P.D. vs. 330 G.P.D. req'd THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING C2 C2 MEDIUM- MEDIUM- CONSTRUCTION. D 10. EXISTING CESSPOOLS TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. 2.5Y 6/6 2.5Y 6/6 PROPOSED SEPTIC SYSTEM UPGRADE PLAN REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. 61.30 132" 61.40 132" 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION 53 MIDWAY DRIVE, CENTERVILLE, MA 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY <2MIIN/INCH IN 'Cl" SOILS Prepared for: Cer Uelra AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY NO GROUNDWATER OBSERVED 13. NO PRIVATE WELLS WITHIN 150' OF PROPOSED LEACHING. Engineering and Survey by: SCALE DRAWN Meyer. y certify approved b MADEP MEYER&SONS,INC. N.T.S. DMM 14. NO WETLANDS WITHIN 100' OF PROPOSED LEACHING. • I, Darren M. M r, R.S., CSE, hereby ceRi that I am currently PPr Y Pursuant to 310 CMR 15.017 PO BOX981 A - to conduct soil evaluations and that the above analysis has been performed by me consistent with the . DATE"15. ALL PIPING TO BE 4' SCH 40 ® 1/8"/FT (UNLESS SPECIFIED) EAST SANDIMCH,MA 02537 CHECKED SHEET-NO. requirements of 310 CMR 15.017. I further certify that I have passed the Soil Eval. Exam in October, 1999. 508362-2922 04/26/17 DMM 2 of 2