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HomeMy WebLinkAbout0494 STRAWBERRY HILL ROAD - Health 494 STRAWBERRY HILL RD.,HYANNIS A= 248 023 I i i I I 4 I D Commonwealth of Massachusetts °?qg D Tale 5 Official Inspection Form . - III Subsurface Sewage Disposal System Form - Not for Voluntary Assessments c / 494 Strawberry Hill rd u Property Address I Kara Costa Owner Owner's Name information is Centerville A'YIIL,SI S Ma. 02632 7-27-20 required for every 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. i Imngoutf forms A. Inspector Information s'1# M::�l filling out forms on the computer, Michael Sears use only the tab key to move your Name of Inspector cursor-do not Robert B Our Co INC. use the return Company Name key. 363 Whites path Company � Company Address South Yarmouth Ma. 02664 . City/Town State Zip Code 508-477-8877 SI 14430 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 IN OF I&k�//b// 2. ❑ Conditionally Passes `�o���.• ssy'% 3. ❑ Needs Further Evaluation by the Local Approving Authority MICHAEL 'yN i =0. SEARS :4 I 4. ❑ Fails * No.SI141430 y �`' ' '��, � •,of �o,:�. S P,E;'` �� 7-27-20 Inspector's SignatInspector's Signat e- Date f 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. l5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 I i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every page. City/Town . State Zip Code Date of Inspection C. Inspection Summary i Inspection Summary: Complete 1, 2, 3, or 5 and all of 4 and 6. 1) System Passes: ® I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: I I t i 2) System Conditionally Passes: I ❑ 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 j 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 i Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N FIND (Explain below): I I i i t5insp.doc i rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 18 i c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ............ 494 Strawberry Hill rd u Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes (cont.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): i 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 c Commonwealth of Massachusetts �n Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments V � 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every 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: i ❑ 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. I ❑ 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: i **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. I c. Other: I i I I I 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: i I 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 i ❑ ® due to an overloaded or clogged SAS or cesspool t5insp.doc rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 18 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CM 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section CA. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA) or a mapped Zone II of a public water supply well t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 i Commonwealth of Massachusetts �n p Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cam !% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. Cityrrown State Zip Code Date of Inspection C. Inspection Summary (cont.) If you have answered "yes" to any question in Section C.5 the system is considered a significant threat, or answered "yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] t5insp.doc-rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form i; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 494 Strawberry Hill rd u Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms (design): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 Description: 1* 3 Number of current residents: Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2018-35000 gal2019-32000 gal Detail: Sump pump? ❑ Yes ® No Last date of occupancy: present Date t5insp.doc:•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts : Title 5 Official Inspection Form III Subsurface Sewage Disposal System Form -Not for Voluntary Assessments < !% 494 Strawberry Hill rd V Property Address Kara Costa Owner I Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. Cityrrown State Zip Code Date of Inspection i D. System Information (cont..) 2. Commercial/Industrial Flow Conditions: i Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow (seats/persons/sq.ft., etc.): i 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 I i Other(describe below): I I 3. Pumping Records: i Source of information: March 2020 Was system pumped as part of the inspection? ❑ Yes ® No i If yes, volume pumped: gallons I How was quantity pumped determined? Reason for pumping: i I t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 I f c Commonwealth of Massachusetts �n Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 494 Strawberry Hill rd u— Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. Cityfrown State. Zip Code Date of Inspection D. System Information (cont.) 4. Type of System: I ® Septic tank, distribution box, soil absorption system i ❑ Single cesspool ❑ Overflow cesspool i ❑ 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): i Approximate age of all components, date installed (if known) and source of information: 6-9-16 #2016-213 { Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. BuildingSewer locate on site plan): ( p ) i i Depth below grade: 28"feet i G Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): l f Distance from private water supply well or suction line: feet Comments (on condition of joints, venting, evidence of leakage, etc.): 1 I t5insp.dod-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 I c Commonwealth,& Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments u 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): 18" Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 gal If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gal Sludge depth: 4" Distance from top of sludge to bottom of outlet tee or baffle 24" 2" Scum thickness 8„ Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Sludge gudge, tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 1000 gal tank both covers at 10"with in and out tees t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 18 c , Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 494 Strawberry Hill rd u- Property Address Kara Costa Owner Owner's Name informat on is required for every Centerville Ma. 02632 7-27-20 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness' Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum'to bottom of outlet tee or baffle Date of last pumping: Date Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 18 Commonwealth of Massachusetts p Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments g!% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank (cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments (condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box (if present must be opened) (locate on site plan): Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D box is 16x16 with 2 outlets, box is 36"with cover at 16" below grade j t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 18 i c Commonwealth of Massachusetts Ip Title 5 Official Inspection Form I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 494 Strawberry Hill rd Property Address Kara Costa - Owner I Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" I Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): I I I * 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): i If SAS not located, explain why: I i I I I Type: ❑ leaching pits number: ® leaching chambers number: 2 i i ❑ leaching galleries number: ❑ leaching trenches number, length: i ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: t5insp.d Ic•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 18 i II Commonwealth of Massachusetts p Title 5 Official Inspection Form _ I Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 494 Strawberry Hill rd LIB Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 11. Soil Absorption System (SAS) (cont.) Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of i vegetation, etc.): SAS is 2-500 gal dry wells clean and dry with no sign of failure i i12. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): j Number and configuration- Depth—top of liquid to inlet invert Il Depth of solids layer 4 Depth of scum layer i I Dimensions of cesspool i I Materials of construction Indication of groundwater inflow ❑ Yes ❑ No Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): i i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 18 i I Commonwealth of Massachusetts Title 5 Official Inspection Form �I Subsurface Sewage Disposal System Form - Not for Voluntary Assessments u— 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy (locate on site plan): Materials of construction: I Dimensions j Depth of solids Comments (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): I I I I I I I I Ii I i i t5insp.doc-rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 18 I Commonwealth of Massachusetts I P Title 5 Official Inspection Form � ,: I; Subsurface Sewage Disposal System Form -Not for Voluntary Assessments !% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is required for every Centerville Ma. 02632 7-27-20 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells 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 I i i I I A . I I B i I `I55 liL' I 3 6gVT 'c' o y Y/5'4ti'y" `rf 7 le,� I i t5insp.doc•rev.7/26/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form �0 Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every page. CitylTown 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 round water: 184 p g g 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 Contour Map 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 . i c , Commonwealth of Massachusetts w Title 5 Official Inspection Form I. II; Subsurface Sewage Disposal System Form - Not for Voluntary Assessments !% 494 Strawberry Hill rd Property Address Kara Costa Owner Owner's Name information is Centerville Ma. 02632 7-27-20 required for every page. I City/Town State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form inclusive of: i ® A. Inspector Information: Complete all fields in this section. I ® B. Certification: Signed & Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: I 1, 2, 3, or 5 completed as appropriate 4 (Failure Criteria) and 6 (Checklist) completed 1 ® 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 I I - I e I 8011�oor, o-F SA S I$, I I 13 I I t5insp.doc•rev.7/2 612 0 1 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 I TOWN OF BARNSTABLE LOCATION 4 q N SrgflL6,7C,1 RL61 VJ SEWAGE# VILLAGE k; e s:` ASSESSOR'S MAP&PARCEL a14 !I INSTALLER'S NAME&PHONE NO. �Cy62P'T P0.00r CO3 SOS-43a- 0530 SEPTIC TANK CAPACITY 1000 LEACHING FACILITY: (t"d) Sw pa L, GkAvffi ,<S (size) ois�A lel.g NO. OF:BEDROOMS 02 OWNER ® 1V -91 C�N PERMIT DATE: COMPLIANCE DATE: 2 3 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) f V Feet FURNISHED BY coo" i i � O f s DI e• DD ass l�� r D i r g - ct No. (� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS ftpl Cation for Bisposal *pstem Construrtion Vrrmit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or 't No. �(1( S1_CAV-*a'Z �� a� wner's Name,Address,and Tel.No. a,r��49I a--o U C—eA4W11sV It be*C_ Assess ap/Parcel- {"e, 1 0 G vQ„c- FA- ilmo, o p Installer's Name,Address,and Tel.No.5oSi—4 3D,— 63 b Designer's Name,A�ress,and Tel.No. �G�— 4 0 4 Q e.1-� , O u f Co,a 1j(_ !BASS Kwe.� ��1 A3 Q.Z1r)A Type of Building: Dwelling No.of Bedrooms Lot Size A rl sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) _Z 2—0 gpd Design flow provided 3 q I gpd Plan Date (,0 Number of sheets Revision Date Title Size of Septic Tank t 000 Q Q 1 _ E) ISS1AG Type of S.A.S. Sa® Cq1, C 1nQ"_r�nV1�c e`,S Description of Soil Nature of Repairs or Alterations(Answer when applicable)5N S fq 1,1 ��'� O `, (3), Sob q Cc I I O N 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 Environmen 1 Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. S lgrlod7Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. 70�� Date Issued An i P 1 No �� 13- Fee i W . THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: > "_ PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for'33isposal 6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or �t No. C(� S j jrA Cry ��OX Qwne�N,Se,Addreess,and Tel.No. jLj g, 4 a-- U Assesso ' ap/Parcel 4 S N r1.e t` �,R 0 (7'trVA \.C- ���IMVJ �ON �41� 1/0 Installer's Name,Address,and Tel.No.S( 4 3��-Qrj3 0 Designer's Name,A ress,and Tel.No. 56IS"3 �" C�y fZC, r-r O U C Co,+O L SASS RAve.C" ti c-1�e.¢.rl Q6 NARw�c1, ti- o�WS- ,o •c3 x t .O�eN1S M (�.6y Type of Building: Dwelling No.of Bedrooms Lot Size , � sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) ;- Other Fixtures Design Flow(min.required) Z 2- 0 gpd Design flow provided 3 q gpd Plan Date �p lb 6 Number of sheets Revision Date Title Size of Septic Tank 1 000 G Ct I . EA1 S i)NG Type of S.A..Sp. t� Soo 1• C� Y-/�y 6 t"S Description of Soil 1'IG f 1? r,N 57 I G A M-1 S /a,.1 V ` HbC\Z.O N' Nature of Repairs or Alterations(Answer when applicable):INS'r4 e 1 ��W �"Q O X 1� SOb C1 C� �. (�/V Date last inspected: Agreement: t 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. Sign Date 617 Application Approved by Date t% Z) <b Application Disapproved by Date for the following reasons Permit No. �,(� �' Date Issued 6 2/ THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded( ) Abandoned b R 0( ) y 2 -1 Dd V nCo . -M►jC. at 4 9 LI S'r&A tk)6e C ry 1 1 I Rd has been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No.701( —213 dated 6(Z[L5b(j Installer Designer #bedrooms 2^ Approved design flow ZD gpd The issuance oft iY;T it shall not be construed as a guarantee that the system will nc on design d. Date l l7 Inspector - - --------------------- --------------------------------------------------------------------------------------------------------------- No. Zo 16 —Z 15 . . - Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal 6pstem Construction Vermit Permission is hereby granted to Construct( ) Repair( ) Upgrade( ) Abandon( ) System located at S r# A W sae,c-req k1)11 'Rd P and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this permit. Date &/v I-30(�7 Approved by _4z"- 1 , Town of Barnstable Regulatory Services �.. Richard V. Scali,Interim Director • anar srABM • NAM Public Health Division Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer&Designer Certification Form Date: C•2-1.11 Sewage Permit#JXAG—aJ3 Assessor's Map\Parcel Designer: - NoMAS McL.ELu40 , p• Installer: +`®�� 9,QVP, Cd ��C•- Address: 66x 1163 Address: P�O • to N 5 -5- ZENOIS . MA 67-fg1 On ����`l b R06 CT $- D u k CO,issued a permit to install a (date) (installer) septic system at g1Jt4 STJ2AW��LR`( 14n L-P—j based on a design drawn by (address) T146In1A S M c +-�U.AN, P.E. dated PEVjS-ErJ 4.20.1.. (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. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system)but in accordance with State&Local Regulations. Plan revision or certified as-built by designer to follow. Strip out(if required)was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in compliance with the terms the IAA approval letters(if applicable) ' •."5 (Installers Signature) % (Designer's Si e) (Affix Design W&a—mp Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc TOWN OF BARNSTABL LOCATION W�' N T Fl y ► ,� S E#� - _ Jl►•� VILLAGE C=* ~ - ►, t t.,t ASSESSOR'S MAP& PARCEL� ,4 /0,- INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY 1006 LEACHING FACILITY: ("e) S(x)C r4 L. C1 R m6, `, (size) NO. OF BEDROOMS O< OWNER Q tJN r th PERMIT DATE:A. La COMPLIANCE DATE: 23 a Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Private Water Supply Well and Leaching Facility(If any wells exist on Feet site or within 200 feet of leaching facility) AJ Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ' fZ 8 5�Ac LN / .� .e A J O I 336 6 ?y S q�� ci h • la Town of Barnstable P#_/5-D. Department of Regulatory Services n anrwarear�a 1 Public Health Division, Date , / ra19� '200 Main Street,Hyannis MA 02601 (� CAL Date Scheduled Time D IqNI Fee Pd._ ��r oy Soil Suitability Assessment for Sew a Disposal Performed By: Witnessed Hy: '�117� le5 LOCATION&.GENERAL INFORMATION Location Address Owner's Name E>'C K ) 99q �`�-� �✓ Address SA' d?f'yf Assessors Map/Parcel: , A� Engineer's Name TWAI P15 MC,1,E ..&J.. NEW CONSTRUCTION REPAIR Telephone# 90 5 '' 3 0° TO tA . Land Use- Slopes(%) . I Surface Stones N� Distancea from: Open Water Body NA ft Possible Wet-Area IV ft Drinking Water Well —AL& _ft Dmlhage Way L+4 t ft Property Line ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Para tests,locate wetlands in proximity to holes) Y6A6 4 to AP v 1 Ty l PI ivy 5T Parent material(geologic) (30-rw4A Depth to Bedroak - —- Depth to Groundwater. Standing Water In Helle^e:_NQNE Weeping from Pit Paco Estimated Seasonal High Oroundwater DETERMINATION FOR SEASONAL' IIGDWATER TABLE Method Used: NA Depth Observed standing in obs.hole: In. Depth to still mottled! Delith to weeping from side of obs.hole: 111. Groundwater Adjustmant . Index Well•# Rcading Dato: Index Well level „ Adj,dhetor_Adj.ClraundwaterLevel,,,_• PERCOLATION TEST Data,,... xYtnu,...._, Observation Hole# Time at 9" Depth of Pero LVA QNt Tlma at 6" Start Pro-soak Time @ �� Time(9"•6") End Pro-soak 5 (n IN Rate Min./Inch . /►1/N Site Suitability Assessment: Sito Passed Site Failed: Additional Testing Needed(YIN) Original: Public Health Dlvision 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. Q:ISEPTICIPBRCFORM.DOC DEEP.OBSERVATION HOLE LOG 7 Hole# Depth from Sail Horizon Soil Texture Sdil Color Soil. Other Surfaco(In.) (USDA) (Munselt) Mottling (Stnucture,Stoneg;Boulders, • �sistency.96't3rave1l " ®A L R- (41,L NO 361 s g No . DEEP OBSERVATION HOLE LOG Hole# Z Depth from Soil Horizon Soll Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. A 1-5 10 `t ?. Na P to 1 R- 5/a NU 13Z" M S 2-sl N ,vo DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders.. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color moil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Scopes;Boulders, t Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes- Within 100 year flood boundary No. Yes.,_.. penth of Naturally Occurring Pervious Materlal Does at least four feet of naturally occurring pervlous Inatorial exist in all areas observed thrpughout the area proposed for the soil absorption system? If not,what is the depth of naturally occurring pervious material? __.__. Certification I certify that on _ (date)I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with . the required tra ing,expertise and experience described in�10 CMR 15.017. ti Datm -� • Signature - Q:1SBFrrlMBRCPORM.DOC IN Town of Barnstable Barnstable kzftd .�. Regulatory Services Department P BAMSTABM M"a Public Health Division FD" 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# 7015 1520 0001 2273 3340 May 18, 2016 Dennis Beach 494 Strawberry Hill Road ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 494 Strawberry Hill Road, Hyannis,MA was last inspected on 4/24/2016,by David B Mason, a certified septic inspector for the State of Massachusetts. I The inspection of the septic system showed that the system"Failed" under the guidelines. of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit or cesspool with high liquid level, <12" below inlet(per Town Code 360-9.1) 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. imas ORDER OF T BOARD OF HEALTH M ean,R.S., CHO Agent-of the Board of Health o • �o Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\494 Strawberry Hill Rd Hy May 2016.doc Town of Barnstable 3ARN3fAHLE, p 1 ,�8 Regulatory Services Department rED IMi� . Public Health Division 200 Main Street;Hyannis MA 02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A McKean,CHO Feb 6,'2007 Rev. 7/6/15 DEADLINES TO REPAIR-FAMED SYSTEMS (Town Code §360-44 and Title V: 310 CNIR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline 60 DAY DEADLINE CRITERIA ❑Discharge or ponding of effluent to the surface of the ground ❑Pumping more than 4 times during the last year not due to clogged or obstructed pipe. ❑Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS of cesspool ❑Any portion of the SAS, cesspool,.or privy below high groundwater elevation ❑Any portion of the cesspool withiri'a Zone 1 to a public well ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA ❑ Single Cesspool ❑Any"conditionally passed systems" (broken cover,relocation of a pipe,relocation of a driveway due to H-10 components;-etc) Leaching pit or cesspool with high liquid level,<12"below inlet(per Town Code 360-9.1) OTHER Repair deadline: Q:ISEPTIMDEADL'INES'TO REPAIR FAILED SYSTEMS.doc �, Commonwealth of Massachusetts �023 _ Title 5 Official Insp ection Form — vjtj Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ^M 494 Strawberry Hill Road I 'r Property Address Dennis Beach Owner Owner's Name information is C,elateo4ge MA 02632 April 24, 2016 required for every p page. Citylrown 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. Imng out forms A. General Information fin the out forms on the computer, VV use only the tab 1. Inspector: key to move your cursor-do not David B. Mason use the return Name of Inspector key. David Mason Company Name - 4 Glacier Path Company Address Ffewn�xEast Sandwich MA 02537 Citylrown State Zip Code 508-367-1617 S1287 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority April 26, 2016 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ""This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 �to r�s e Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 April 24, 2016 required for every p 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is required for every Centerville MA 02632 April 24, 2016 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is required for every Centerville MA 02632 April 24 2016 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 '/2 day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24 2016 required for every p page. Cityrrown 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. l5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every p page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened., and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 A rll 24;2016 required for every p page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d Yes 9 ( Y 9 (gp ))� Detail: 2014; 108,000 gallons and 2015; 95,000 gallons Sump pump? ❑ Yes ® No Last date of occupancy: currentDate 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•3113 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 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 A rll 24, 2016 required for every Ap page. Citylrown 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: Board of Health 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts w Title 5 Official In Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every P 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: Installed 1994 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 3feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 1 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: 1000 Typical Sludge depth: 811 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 9 of 17 f Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every p page. Cityrrown 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 36" 5 Scum thickness Distance from top of scum to top of outlet tee or baffle 3" Distance from bottom of scum to bottom of outlet tee or baffle 16" How were dimensions determined? Scour Stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Effluent level with outlet invert. Tank is 12 inches below grade. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every p 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.): 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•3113 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 °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 April 24, 2016 required for every P 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 Not Applicable. Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.). Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): * If pumps or alarms are not in working order, system is a conditional pass._ Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24 2016 required for every p , page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ 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.): 6 foot pit with 2' stone. effluent up to inlet pipe above effective leaching area. Backed up into compenent. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth —top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool / Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every P 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-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 °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 April 24, 2016 required for every p 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 t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is Centerville MA 02632 Aril 24, 2016 required for every p page. City/Town 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: 18 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: Groundwater Contour Map ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Groundwater Contour Map Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °M 494 Strawberry Hill Road Property Address Dennis Beach Owner Owner's Name information is required for every Centerville MA 02632 April 24, 2016 page. 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 t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 i Assessing As-Built Cards Page 1 of 2 TOW Or B TABLE LOCATION__ � �7`y175,e f SEWAGE # 9 _1{ VILLAGE ASSESSOR'S MAP& LOT-)Y9— 0 INSTALLER'S NAME& PHONE NO. ���,�x��� 175 JQ SEPTIC TANK CAPACITY����,L� LEACHING FACILITY:(type) /606 C,.o size) NO.OF BEDROOMS C>I— PRIVATE WELL OR PUBLIC WATER QW Aj BUILDER OR OWNER �FT(s liNSc�.tJ DATE PERMIT ISSUED: —7 /jQ-9 V DATE COMPLIANCE ISSUED: 7•l 7r"!n VARIANCE GRANTED: Yes No cr ^l Xd eM http://www.townofbamstable.us/Assessing/HMdisplay.asp?mappar=248023&seq=1 4/23/2016 T0,w 0, BA tSTABLE� � LOCATION SEWAGE # 9 VILLAGE ASSESSOR'S MAP & LOTC;)y9— da_3 INSTALLER'S NAME & PHONE NO. SEPTIC TANK CAPACITY C d r aic TI LEACHING FACILITY:(type) 16O0 (size) . NO. OF BEDROOMS o2 PRIVATE WELL OR PUBLIC WATER'' BUILDER OR OWNERS DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: 341, VARIANCE GRANTED: Yes No )�v' �.+. r l� ,, \�r �. �. C �' f� i� '' i �� ,�� .� � R r� ,, . , - , � . . � � 1 Alan Goodman 494 Strawberry Hill Road Canterville,Mass. 02632 v� ' a It So je�xrr ©l� �'�'�- TOWN OF BLE 1� LOCATION SEWAGE # VILLAGE a ASSESSOR'S MAP & LOT 6a3 INSTALLER'S NAME & PHONE NO. Esc€ SEPTIC TANK CAPACITY l w0 c LEACHING FACILITY:(type) lead., 12;4- t o 4r (size) NO. OF BEDROOMS I PRIVATE WELL OR PUBLIC.WATER 0A 1 c BUILDER OR OWNER Nrr �+.w e' DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No _ Ft)kN4S8ED gy OU)aU va s zz� e C� � Ccv a f l y uT M I No..q.1.'_,3_1__`- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Di-wipm3al Rliarkti Tomitrur#ion Urrutit Application is�i�eby maAe for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at: ........ ................................................................................................. .... 19 Y--- -------- ---= -- cation-Address or Lot No. eRaPl�!1---------------------•-----------•----- ---------------------- w er Address PQ Installer Address UType of Building Size Lot............................Sq. feet ., Dwelling— No. of Bedrooms_____.__"z:.............................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons---------------------------- Showers — Cafeteria A4 Other fixtures ------------------------------ - W Design Flow............................................gallons per person per day. Total daily flow......._._._...._.__..._..._..__._.-___.._..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-___---_-. -_--.-.- Diameter____________________ Depth below inlet.................... 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........................ fi Test Pit No. 2................minutes per inch Depth of Test Pit_---_-____________ Depth to ground water........................ -------------------------------------------------------------------------------••-•;•-••-•-••••-------•----------------•-•••-............................... 0 Description of Soil....................................................................................................................................................................... W U •------------------------------------•--------------------------------------------------------...-------•------------------------------•--- W ----------------------------------------------------------- -----------------------------•--------------------------------------------------------------------------------------------------- •_.._. VN re of Repairs or Alterations—Answer when a pli ble...................----_ -__---.____.-._____-_-____ __--_.......--- ---- ........... Agreement: -��'i�• The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Complian s been iss ed y board ealth. �Signed ----------- ---- ---- . . Date Application Approved By ...................1 ............................... .......7-=i.. ..-. . Date Application Disapproved for the following reasons- ------------------------------- -------- --------------------------------------------------------------------------------------------._.....�es�` .................................. ................ ...........; t 'f*M Date Permit No. � ................q .................. a I Issued .....Iss ..................... ............................ .... i ' Dace IY} ------------------------- No....l. :_1�� ��Fim ................. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for Biiipwml Work,i Tomitrnrtion jintu t Application is hereby made for a Permit to Construct ( ) or Repair (p, ) an Individual Sewage Disposal r System at: , t � e,,, `�, �1�t 'C , /� , � � ,•�'',�`' F 10 cation-Address ' C` or Lot No. 1L� . a Ow er + ...... --- ---------------------Address ---•--------- ..... ._..._.......... f A Installer Address �" d Type of Building Size Lot........" .....Sq. feet Dwelling—No. of Bedrooms-------- -_____-_•---------------....Expansion Attic ( ) Garbage Grinder (A-) aOther—Type of Building ---------------------------- No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Other fixtures ---------------------------------------------•----••- W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity?E.="_!4�galIons Length---------------- Width---------------- Diameter---------------- Depth-----_-____----. x Disposal Trench—No. ................... Width-------------------- Total Length.................... Total leaching area--------------------sq. ft. Seepage Pit No._�.j7t' 3. V'Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. z Other Distribution box( ) Dosing tank Percolation Test Results Performed by------- --------------------•-------•-•-----•-----•---••-•------------•-- Date.--------.............................. W Test Pit No. I----------------minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ 4.1 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P+ -... •--------------------------------------------------------------------------- •------------------- ------------- -••-•-•----------------•-----•-----•-•_----- 0 Description of Soil.............................................................................--------------------------...-------------------------------------------------------_----. W VNature of Repairs or Alterations—Answer when appli bD ----------------------------------------------• -- Agreement: lfao'j crydv -�dc� /�� 02ye- The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of CompliancC h`as been issued by fie board of health. r f/� SignedM ...... . i (/ Dace Application Approved By ------------------ ----- ------------------------------- --------/-.--�. . te Application Disapproved for the following reasons: .................................................... ................ . ........ . ...... ............... ...................................................... . .... ............ ........ Dace PermitNo. ---------� -.----�.. -/.......................... Issued .......................... . ............. .. Dace THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Te>r#ifi ate of Compliance THIS IS TO CERTIF That t Individual SS ..wage Disposal System constructed ( ) or Repaired ( v� by ---------------- ........ '- ..._.... I- - - .... .. .._................................................ .......................--- . ... I s�.tee at -------------- ------ ---------------------------------------------------- /...... ! ...'----. ......----------------------------------------------------------------- has been installed in accordance with the provisions of TITLE 5 ofThe State Environmental Code as described in the application for Disposal Works Construction Permit No- ----------- ------ dated ....-.................._------_..__._... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. �-- G� '/�f �.. 1 DATE-----x ..`",'......L.... ...- --�..., ----------------------- Inspector ------ - -...j..._._.. � - ........ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH No.---- TOWN OF BARNSTABLE •---�---.�?_�I/ FEE..-3G.-•�---- Roposall orki notrudi.on "rrntit Permission is hereby granted------- ��2nw ............. e• to Construct ( ) or Repair / ) an Individual Sewage Disposal System atNo.--...�1�------e--'�- ---•---1 ?� -- -------------------------- , Street as shown on the application for Disposal Works Construction Permit No.. , Dated......� ..'�� ..`..,1� -..-. Q� _ bard of Health DATE................ �) L�I..................................... FORM 36508 HOBBS&WARREN.INC..PUBLISHERS -------------- R BOOK__ PAGE-;P-/- i•rrnR . RFGISTRYLL 'U'rTY ' a'ao p0 IOHN F.M C'•EAf ADS -1 N E N.F L A `20 �6 JOHN H. MURPHY W 'SEAGA TE a•,,5 8891117J ro 1 F WAY 40' WIDE PS 194115J a g CBiDq - PRIVAT � r 2 26.4 so F . 0 \. 'ol• DN. p S. SO.Oo.. J eJ•//'4e'•E THIS PLAN HAS BEEN PREPARED IN CONFORMITY WITH H 7491 '� S.F. /23.83- THE RULES AND REGULATIONS OF THE REGISTERS OF DEEDS FOR THE COMMONWEALTH OF MASSACHUSETTS. V m N/F n MICNAF14URP 6 KIMBERLY i ift�e l-. DATE PROFESSIONAL LAND SURV FOR 3 w IJ471/708 Qj as , t a i o N/F y e 4 `THOMAS TRUST u 12080122 All. • y 4 S�O•J�Je. •.a• •1 J0 A BRB FND CBi SO.OO• 'j's — J// /4 SfT} e/.JS• S0 row, P L .4 /V OF L A NO �N WAY - THE PROPERTY LINES SHOWN HEREON ARE THE LINES !N DIVIDING EXISTING OWNERSHIPS. THE LINES OF STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC OR ( SA R/V S TA R L E . "A PRIVATE STREETS AND WAYS ALREADY ESTABL ISH£D. OWNERS OF RECORD: C V M NO NEW LINES FOR DIVISION OF EXISTING OWNERSHIP -- PR EPAREO FOR OR FOR NEW WAYS ARE SHOWN. DENNIS BEACH 494 S STRAWBERRY�'NILL ROAD O E N B E,�I C H CE E NTERVILL MA 14948/125 SCAL E: / — 20 OECEMBER 24 . 2003 DATE PROFESS/ONAL LAND SURV OR REVISED JAKUARY 14. 2004 i NOTE EAGLE SURVEY I NG I NC ' 'THE ABOVE lS INTENDED TO MEET REGISTRY OF DEEDS THIS PLAN CORRECTS AND SUPERSEDES A PLAN C:`�-�IL,JCI�; 923 Route 6A REQUIREMENTS AND IS NOT A CERTIFICATION TO THE RECORED 1N PLAN BOOK 587'PAGF 97. /i��Z,�F / ` =—� Yarrriouthport MA. 02675 TITLE OR OWNERSHIP OF THE PROPERTY SHOWN. OWNERS (508) 362-8132 OF PROPERTIES SHOWN ARE ACCORDING TO CURRENT TOWN f (508) 432-5333 ASSESSOR'S RECORDS. ff4 JOB NO: OJ-126 FJELD: CFW/EEK CALC: CFW CHECK: SAH DRN: CFW EXISTING o os CONTOUR:R: ............. SEPTIC SYSTEM DESIGN SEPTIC SYSTEM SECTION mM'9/NST EXISTING SPOT ELEVATION: 25.5 FLOW ESTIMATE: 2"PEASTONE OR FILTER FABRICCOVERS WITHIN 6" 3/4"-1 1/2" PROPOSED SPOT ELEVATION: 25.5 2 BEDROOMS AT 110 GAL/DAY= 220 GAL/DAY 100.73 D TEST HOLE: TOP OF �; OF FINISHED GRADE N UTILITY POLE: �- __j ° FOUNDATION 7-, " -m;. _ WASHED STONE D m r, ,. . ,,,aT,, INSPECTION PORT -� FENCE LINE: SEPTIC TANK: �p HYDRANT: 220 GAL/DAY x 2 DAYS= 440 GAL '"^3% ^ ELEV.=97.18 4 , Z RETAINING WALL: p1NEST USE - 00 GALLON SEPTIC TANK (EXISTING) ELEV. a COVER ° 97.1 (1'MIN) LEACHING AREA: ELEV. OCUS EXISTING 9 .7 96.58 USE 2-500 GALLON CHAMBERS(8.5'x 4.8'x 2'EFF.DEPTH)WITH 97.4 ELEV. ELEV. ° ° 94.18 LOCATION MAP ELEV. PARCEL 23 (7,487 SF) D-BOX H , H ELEV. 4'OF STONE ALL AROUND (25'x 12.8'x 2'DEEP) ° 1000 GAL (6"STONE UNDER) 4' 4' ASSESSORS MAP:248 PARCEL:23 SEPTIC TANK 25'x 12.8' PLAN BOOK:219, PAGE:111 SIDE AREA: (25'+12.8')x 2 x 2=151 SF (0.74)=112 GAUDAY TEE SIZES: (TO BE CONFIRMED) 96.1 2-500 GALLON CHAMBERS WITH BOTTOM AREA: 25'x 12.8'=320 SF (0.74)=237 GALrDAY INLET:6"UP, 13"DOWN 4'OF STONE ALL AROUND OUTLET:6"UP, 14"DOWN ELEV. (25'x 12.8'x 2'DEEP) CAPACITY=349 GAUDAY GAS BAFFLE (EH-20)_ AT OUTLET TEE (TO B VENTED) N BENCHMARK AT MAG NAIL TH-1 100.0 TH-2 100.0 ELEVATION=100.0 SEAGATE LANE kitchen bed TEST HOLE LOGS O/A HORIZON E�� O/A HORIZON ELEV. living room LOAMY SAND LOAMY SAND ENGINEER: THOMAS McLELLAN,P.E. / room bed 10YR 4/2 10YR 4/2 ® , o room WITNESS: DAVE STANTON,R.S. 10" 99.2 6" gg.5 Ed a of Pave / ' a dining bath B HORIZON B HORIZON 100 _ 100 room DATE: 6-9-16 10YR 5/8 AND 10YR 5/8 AND PERCOLATION RATE: <2 MIN/IN 30" 97.5 30" 97,$ � C HORIZON C HORIZON i laundry MEDIUM SAND MEDIUM SAND i 63,1g �-'� 2.5Y 7/6 PERC AT 48" 2.5Y 7/6 i STONE DECK c ONE DRIVE 126"1 89.5 132" 89.0 1 � Q \ EXISTING FLOOR PLAN NO GROUND WATER ENCOUNTERED 100:I , ��� th-2 _ NOTES: 1 '� = beech8 m th-1 10' 1.VERTICAL DATUM: ASSUMED 2.MUNICAPAL WATER IS AVAILABLE. �) I✓ LP l i SHED 3.SCHEDULE 40-4"PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 4 4,ALL PRECAST UNITS SUBJECT TO TRAFFIC LOADS TO CONFORM WITH AASHTO H-20 SPECIFICATIONS. ST existin epto ganlon 5.PIPE PITCH= 1/4" PER FOOT(UNLESS NOTED OTHERWISE). W1 7d4n k 6.FIRST 2'OF PIPE OUT OF D-BOX TO BE SET LEVEL. 7.THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE USE OF A GARBAGE DISPOSAL. C.O. 8.ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE STATE OF MASS.ENVIRONMENTAL / ry CODE(TITLE FIVE)AND LOCAL HEALTH REGULATIONS. 100 E E 9.CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR TO CONSTRUCTION. m bh �101 10.GROUND COVER OVERALL SEPTIC SYSTEM COMPONENTS NOT TO EXCEED 31. CO fives 98 6 / 11.FIELD SURVEY PROVIDED BY TERRY A.WARNER,P.L.S.,HARWICH,MA. �G 12.THIS PLAN REQUIRES THE REVIEW AND APPROVAL OF ONE OR MORE TOWN DEPARTMENTS AND 4fQ IN IS SUBJECT TO CHANGE UNTIL SUCH TIME. 13.EXISTING LEACH PIT IS TO BE PUMPED AND FILLED WITH SAND OR REMOVED. Cd 14.D-BOX TO BE WATER TESTED TO ENSURE LEVELNESS AND EQUAL FLOW. _ 2 BISTING BECK DNEE)ROOM 15.THIS DESIGN REQUIRES THE APPROVAL OF THE FOLLOWING VARIANCE FROM TITLE 5: top fnd_ G SECTION 15.240(7):SMALL PORTION OF LEACH AREA TO BE UNDER DRIVE WAY. LIN 100.73 16.THIS PROPERTY FALLS WITHIN A ZONE 2 AND UNDER CURRENT REGULATIONS IS RESTRICTED TO 2 BEDROOMS. J / SITE PLAN 101 r LOCATION: j 494 STRAWBERRY HILL RD.,CENTERVILLE,MA o " z "ft TO o6 . o s PREPARED FOR. �4t / (��; � _i�� DENNIS BEACH DATE.6-9-16 SCALE: 1"=20' � � 1 1 P REVISED:6-20-16 2 BEDROOM DESIGN CALCS. 8.19, , ; BASS RIVER ENGINEERING THOMAS J. McL AN, P.E. P.O.BOX 1163, EAST DENNIS,MA 02641 M16-25 508-364-9048