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0008 THOREAU DRIVE - Health (2)
8 THOREAU DRIVE, CENTERVILLE ® = 2m llli UPC 12534 No.21.. 5..�:ORPosrcoNs°�� HASTINGS,MN t• AMMMI R- I No. Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION —TOWN OF BARNSTABLE, MASSACHUSETTS Yes \ Applitation for Misksal *pstem Construction 3permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. oreo() f 1 Q C O is Name dress an Tel.No. ry - 4 g 7- g Assessor's Map/Parcel �l 191 _Parbe 110 T'etuz. ' c�0�K4` Installer's N e,Address,a d Tel.No. Dgsjg}�er's Nams,,and Tel.No. T3-t 8 �XCQ V Git ivn 5 0 k-4 T]-D653 ��5��11GGG�PP..(( T f b 1� 5 D g-3 z - z.9 2 2 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) gpd Design flow provided gpd Plan Date 5 15 ( - Number of sheets Revision Date Title i Q Size of Septic Tank�D� (eci5+1nQl Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o alth. gn ,4 Date 1( 1�2 Application Approved by Date Application Disapproved by 77 Date for the following reasons Permit No. "- Date Issued TOWN OF BARNSTABLE LOCATION $ -T k or Gau --13r. SEWAGE# r901,1-3 9 a. VILLAGE Ccnacr u i 1 I c.. ASSESSOR'S MAP&PARCEL 19 1 - 1,070 INSTALLER'S NAME&PHONE NO. W Q EXCayam-1i ar, q 97- OGS3 SEPTIC TANK CAPACITY 1000 9a� LEACHING FACILITY.(type) {mac S ARcti 3L (I (size) 11,,T i NO. OF BEDROOMS OWNERa- PERMIT DATE: I Z-10-)Z COMPLIANCE DATE: Z-)3•)'Z Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY A I � AZ- `� A3-3z" B3- Ay-s s° 43LI 3 No. Fee- THE COMMONWALTH OF MASSACHUSETTS Entered n computer: r` 4 PUBLIC HEALTH DIVISION -;TOWN OF BARNSTABLE, MASSACHUSETTS Yes \ Rppliratiou for DIsposar6pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. �"$, ' A hUreo L) D-r O ner's Name, ddress and Tel No. ,-.{ � ' Assessor's Map/Parcel --'�'1 I I !fin rc e I l Zp I �r)Cz. `� - ( y Installe 's Name,Address,and Tel.No. Des' er's ame,Address nand Tel.No. 1 t C Xcz)V6_j IU(1 509- '� 7]-U65.3 � r, , Au� I Q (oZ -� 2 2 �- `� 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) `a 3 D gpd Desig flow provided gpd Plan Date ' 2 Number of sheets Revision Date Title 1 L \/� � \)�f i C 1� Size of Septic Tank (t x i`a i 1 i 1 Ci 1 Type of S.A.S. Description of Soil Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of-Health. Date I ( Cl G Application Approved by (� U (� Date Application Disapproved by Date for the following reasons —ter Permit No. '~ Date Issued e;�Ila i. THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS (Certificate of Compliance THIS IS TO CERTIFY that the On-site Sewage Disposal system Constructed( ) Repaired(✓) Upgraded( ) Abandoned -)by )6�-1 X[(jo/ I L,1 n at r� has been Aconscted' accgFd with the provisions of Title 5 and the for Disposal System Construction Permit a efioInstaller (1 ��� -'1 I �� (�\l Designer ��/ { #bedrooms `� Approved design flow 313 gpd The issuance of this permit shall n be cons,e a guarantee that the system w' function es ned. Date / �— Inspector `ti V" ------\J ------�.---------.:----------------- --- --------------- -----------_- ---- _-------- No. � Fee HE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Disposal *pstrm Construction 3permit Permission is hereby Agranted to Construct( ) 'Repair(`'`) Upgrade( ) Abandon( ) System located at t I 1 o -(�'(� @ Q2 l J (' C�.��"t l (,AV 1 ( � 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:Construct n must e c• pleted within three years of the date of this permit. / Date �O Approved by V / Town of Barnstable ' I. Regulatory Services Thomas F. Geiler,Director Public Health Division Alga ' Thomas McKean, Director 200 Main Street,Hyannis,MA 02601 t Office: 508-362-4644, Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# COI a - 2 9 a Assessor's Map\Parcel 00 Designer: Installer: LC_Xcctuco i o y Address: � � Address: i y '1-cm S-r r W LrJ On Q 64 3 EXCeauocl i o,\ was issued a permit to install a (date) (installer) ' septic system at based on a design drawn by (address) dated 1 ( esi�ner) 1 certify that the septic system referenced above was installed substantially according to the design, which may include minor approved chan,2es such as lateral relocation of tlz:. distribution box andb"or septic tank. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or anv 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. OF Mgss9C • . DA _EN (Installer's.Sign e) m N :/1'f4d GISiE�� SO ITWP� esigner's Signature) (Affix Designer's Stamp Here) PLEASE RETURN TO BA N ABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS-BUILT CARD ARE RECEIVED BY THE BARNST.ABLE PUBLIC HEALTH DIVISION. THANK YOU. Q: Heal th/SepticiDesigner Certification Form 3=2674.doc I down cape engineering, inc. SIEVE SOILS ANALYSIS 8 THOREAU DRIVE CENTERVILLE, MA DATE OF REPORT:1/4/12 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 8 THOREAU DRIVE CENTERVILLE, MA LOCATION: DARREN MEYER TESTHOLE la /a /I► SIEVE ANALYSIS Weight Sample(Grams): 262.7 SIZE :WEIGHT RETAINED % RETAINED % PASSED ---------- -(sum ........... ------------- -- 1" 0.0: ------------ -------------------------- --------------------- ------------------ 3/4" 0.0: 0.0% 100.0% •-------------{------------------.-------•-t----------------20- :L-----------__•-% 1/2" 0.0; 0.0%: 100.0% --------------f------•-•-----------........------___�-___- 3/8" 0.0%r---------100.0% #4 0.0: 0.0%; 100.0% .------------•-._-.---•.................e---------------------I.................. #10 39.1: 14.9%: 85.1 •-------------4..........................A---------____--------4..-......---...... #20 142.2: 54.1%� 45.9% .-------------L.......................-..5-------------_-------L........... ....... ' #40 223.8: 85.2%; •-------------f...........................f----___________------f.................. #50 243.6; 92.7%; 7.3% ------------: - - .. -----.-------------------- .................. 254.9: 97.0%: 3.0% ------------=,.............-..... ..... -------------------- - - ....... #100 ' ------------------ 256:1;-------------97 5%�----------- 2=5% #200 257.9: 98.2%; 1.8% --------------(------•----------------•---f---------------------�------------------ PAN: 260.3; 100.0% 0.0% ------------------------------------ f- T---------------------------------------- SAMPLE: 262.7: NOTE:TEST ON PASSING#4 ONLY, 28.4% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #5010%-100% 7%SLIGHTLY TOO COARSE #100 0%-20% OK #200 0%-5% OK SAMPLE CLOSE TO MEETING TITLE 5 FILL SPECIFICATION >98%SAND RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN. MATERIAL �i�� NCFM�SS9C� NONCOMPACTED ��So DAN!ELA. N - SOIL DESCRIPTION: SAND o OJALA CIVIL C No.46502 ALE �' Y ' 1 APPLICANT: ADDRESS: DESIGN FLOW: T gpd REVIEWED BY: DATE: Grp. N/A OK NO Le al boundaries denoted [310 CMR 15.220(4)(a)] Street, Lot, tax parcel number and lot number noted on plan [310 CMR 15.220 4 (u ] Locus Provided [310 CMR 15.2204 t Plan proper scale? (1"=40'for plot plans, 1"=20'or fewer for com onents) [310 CMR 15.220(4)] Easements shown [310 CMR 15.220(4)(b)] System located totally on lot served [310 CMR 15.405(1)(a)for u ades]- i not, a variance is required [310 CMR 15.412(4)] Location of impervious surfaces (driveways,parking areas etc.) [310 CMR 15.220(4)(d)] 'f Location all buildings existing and proposed 310 CMR 15.220(4)(c)] Location and dimensions of system components and reserve areas [310 CMR 15.220(4)(e)]• Y S stem Calculations m i CMR 15.220(4)(f)] dail flow �. se tic tank capacity (required and provided) soil abso tion s stem (re uired and rovided) X• whether s stem designed for ar )age rinder North arrow [310 CMR 15.220(4)( )] Existing and Proposed contours [310 CMR 15.220(4)( )] Location and log of deep observation holes (existing grade el. on each test) [310 CMR 15.220(4)(h)] Names of soil evaluator and BOH representative [310 CMR 15.220(4)(h) and (i)] Location and date of percolation tests (performed at proper elevation?) [310,CMR 15.220(4)(i)] Percolation test results match loading rate? [310 CMR 15.242] . Certification statement by Soil Evaluator[310 CMR 15.220(4) ')] Observed and Adjusted groundwater(method for adjustment given or indicated 310 C g ) [ MR 15.103 3 ( ) and 310 CMR 15.220(4)(n)] Location of every water supply,public and private, t310 CMR 15.220(4)(k)] Address_ J1••�t'*�JCAJ4 661*f1 Sheet l of 7 R within 400-feet of the proposed system location in the case of surface water supplies and ravel packed public water supply within 250 feet of the proposed system location in the case I } within 150 feet of the proposed system location in'the case of private water supply wells . Location of all surface waters and wetlands located up to 100 ft. beyond setbacks listed in 310 CMR 15.211 and any catch basins located within 50 ft. [310 CMR 15.220(4)(1)] Water lines`aiid 6theF--subsurface utilities located [310 CMR 15.220(4)(m) (if water line cross see 310 CMR 15.211(1) 1]) Profile of system showing invert elevations of all system components and the bottom of the SAS [310 CMR15.220(4)(o)) Stamp of designer 310 CMR 15.220 1 and 310 CMR 15.220(2)] Stamp of Registered Land Surveyor(required if construction activities within 5 ft. of lot line) [310 CMR 15.220(3)] 5C . Test Holes adequate (two in each of the primary and reserve unless trenches as permitted in 310 CMR 15.102(2)or as approved for an upgrade under LUA at 310 CMR 15.405(1)(k)] ?-- Test hole adequate to demonstrate four feet of suitable material? 310 CMR 15.103(4)] Test Holes adequate to confirm adequate groundwater separation? [310 CMR 15.103(3)] Benchmark within 50-75' of system [310 CMR 15.220(4)( )] Materials specifications noted? [various sections of 310 CMR 15.000] �C System components not> 36" deep(unless Local Upgrade Approval or LUA.requested)13 10 CMR 15.405(l(b) Address �% i ''�f1 '��i✓tr4't' /�° �t�it�- '�! 1 Sheet 2 of r - 1 Size OK? [310 CMR 15.223(1)] Inlet tee located ten inches below flow line 310 CMR 15.227 6)] Outlet tee 14 or 14"+5"per foot for increase ft depth [310 CMR 15.227(6) X Outlet tee with as baffle or approved filter [310 CMR 15.227(4)] Note regarding installation on stable compacted base [310 CMR 15.228(1)] Separation between inlet and outlet tees (no less than liquid de th) 310 CMR 15.227(2) Inlet/Outlet elevations at least 12" above high groundwater (except as described 310 CMR 15.227(5)) or permitted for Ldes under LUA [310 CMS 15.405(1)(k)] um cover 9" (Tanks buried more than 9" must have risers openings and on the d-box) [310 CMR 15.2228(1)and 310 15.232(3)(f)] access covers (inlet and outlet must be 20"or greater)- e access at least 8" (b 7/07) [310 CMR 15.228(2)] s to within 6 " of grade - one port for systems<1000gpd, r s stems>1000 d 310 CMR 15.228(2) grade covers secured to unauthorized access? [310 CMR (2)]from building founCMR 15.211(1)] nc calculation Required/Done r310 CMR 15.221(8)] H-20 Where a ro riate? [310 CMR 15.226(3)] X Setbacks from resources [310 CMR 15.211] Required when other than single-family dwelling or flow>1000 d [310 CMR 15.223(1)(b)] First compartment 200%daily flow; Second compartment 100% daily flow 310 CMR 15.224(2) and 3)] "U"pipe through or over baffle, outlet of each compartment with as baffle or approved filter [310 CMR 15.224(4)] Address ►1t1 .i j �ldd, . Sheet 3 of 7 Located at leastten feet from any waterline? [310 CMR ON M�l 115.222(2)] Disposal piping at least 18" below water line (when water and sewer cross, see 310 CMR 15.211(1 [1]) Cleanouts required/provided ? [310 CMR 15.222(8)] Thrust blocks s ecified in force mains? 310 CMR 15.221(6)(c)) ]Slope of sewer line not less than 0.01 (1/8"/ft) 0.02 preferable [310 CMR 15.222(6)) Proper pitch on all runs? (.005 within gravity-distributed trenches and beds) [310 CMR 15.25](9) and 310 CMR 15.252(2)(c)] Siphonproblem/ leachfield below pump chamber) Endca s or vent manifoldspecified? Size and orientation of discharge holes specified? (not smaller than 3/8" not larger than 5/8") [310 CMR 15.251(8) and 310 CMR 15.252(2)(h)] Materials specified (310 CMR 15.251(5) specifies various pipe types allowed) ' Stable compacted base [310 CMR 15.221(2)and 310 CMR 15.232(2)(a)] Splash plate or baffle tee required on inlet/provided?(when pressure sewer to d-box or steep pitch of gravity sewer) [310 k CMR 15.323(3)(a)] Riser if dee er than 9" [310 CMR 15.232(3)( ] y� Inside minimum dimension 12" [310 CMR 15.232(2)(b)] Minimum sum 6" [310 CMR15.232(3)(e)] X Watertight cover if<2000gpd); waterproof manhole if>2000gpd [310 CMR 15.232(3)(d)] Capacity(emergency,storage above working=design flow)? [310 CMR 231(2)] t ,Proper setbacks [310 CMR 15.211 (same as septic tanks)] 77 IWatertight 20-in minium access manhole at least 20"MUST BE 1 1 TO GRADE [310 CMR 15.231(5)] Service components accessible (not too deep,with piping, disconnects accessible) Alarm floats - alarm on circuit separate from pumps s ecified? Exceeds two units must have two pumps operating in lead-lag mode. [310.CMR 15.231(6) and (8)] Stable Compacted Base [310 CMR 15.221(2)] Buoyancy calculations needed ?Provided? [310 CMR 15.221(8)] ` 1 Address t y� 21 D 1 , � 4A44"- /�� Sheet 4 of 7 I .q Calculations.correct? 4 feet of naturally occurring material demonstrated?[310 CMR 15.240(1)] Required separation togroundwater? 310 CMR 15.212)] Aggregate specified as double washed [310 CMR 15.247(2)] System Venting required/provided? (system under driveway or >36" deep) [310 CMR 15.241] Inspection ports specified and within 3"final grade? [310 CMR 15.240(13) Breakout requirements met?(No violation of breakout elevation within 15 ft of SAS unless barrier) [3.10 CMR 15.211(1)[4] and }� Guidance Document] F' Chambers and Gal. in trench configuration supplied with inlet .� every 20 ft. [310 CMR 15.253(6)] '\ Each structure with one inspection manhole.(if>2000 gpd must be tograde) 310 CMR 15.253(2)] Aggregate I'minimum-4'maximum. [310 CMR 15.253(1)(b)] 2' sidewall credit maximum [310 CMR 15.253(1)(a)] In bed configuration, inlet every 40 s .ft. [310 CMR 15.253(6)] X: Width 2'minimum 3'maximum [310 CMR 15.251(1)(b)] 100 feet-maximum length [310 CMR 15.251 1) a Minimum separation 2x effective depth or.width whichever eater(3x if reserve between trenches) [310 CMR 251 1)(d)] Situated along contours [310 CMR 15.251(2)] Breakout OK? [310 CMR 15.211(1)[4] and Guidance Document] minimum 2 distribution lines 310 CMR 15.252(2)(a)] Maximum separation between lines 6' 310 CM R15.252(2)(d)] Maximum separation between lines and outside of bed 4' [310 CMR 15.252(2)(e)] Aggregate depth below discharge pipes 6"minimum, 12" maximum. [310 CMR 15.252(2)(g)] Pse aration between_beds 10' minimum. [310 CMR 15.252(2)(f)] ottom area used in calculations only 310 CMR 15.252(2) i)] p • Address Dtr1gQL4 9 Sheet 5 of 7 Pressure Dosed System ? Provided pump and piping calculations as re uired.[310 CMR 15:220(4)(r)] Pressure dosing required on all systems>2000gpd or alternative systems undeF�nedial approval [310 CMR 15.254(2) and UA Remedial Use Approvals] If used in gravelless system -make sure jet is directed as not to scour soil interface [Guidance Document] )(° Inspections once per year(systems<2000 gpd) or quarterly (>2000 d Rood to note on lan [310 CMR 15.254 2)(d ] Construction in fill -Did the plan specify that the fill shall meet the s ecification of 310 CMR 15.255(3)? it Im ervious barrier and/or retaining wall ? [Guidance Document] Impervious barrier installation must be supervised by desi ner [310 CMR 15.255(2)(b)] X Retaining wall must be designed by Registered Professional En meer [310 CMR 15.255(2)(a)] Side slo e not exceed 3:1 - 31 - CMR 15.255(2)] Breakout requirements met? [310 CMR 15.252(2)and Guidance Document At least 5 ft. from impervious barrier to edge of SAS (10 ft. recommended) [310 CMR 15.255 (2)(e)] Check DPP A roval letters for credits and design conditions �( If used with pressure dosing do not allow pressure discharge to scour soil interface Was DEP Approval Letter provided and/or have you j reviewed the letter for conditions? Is the technology being properly applied and does it meet all DEP A roval Conditions? �. Is there a note on the plan regarding the requirement for e etual maintenance a eement? An alarms involved on separate circuits Did the applicant submit an operation and maintenance manual? 7 Hasa plicant submitted a coy of a maintenance Are the variances listed on the plan ? [310 CMR 15.220 RLS Stamp necessary on plan if a component is within five feet of ro erty line'[310 CMR 15.412(4)] New construction or increased flow proposed- [Refer to 310 CMR 15.414] Address R *T r� . 00- dVLJe_WVi: Sheet 6 of 7 I Is the system in a Designated Nitrogen Sensitive Area(Zone II for a public supply well)? [310 CMR 15.214, 310 CMR 15.215 and 310 CMR 15.216- also refer to Polie'y regarding upgrades of such existing systems] Is the system proposed on the same lot as served by private well ? [310 CMR 15.214(2)] Are the nitrogen loads proposed in compliance? [310 CMR 15.216(l)] �( Pumping to septic tank ? [310 CMR 15.229] EEE Shared System [310 CMR 15.290 Address `�.�c..�� e.14 Sheet 7 of 7 pFt� o� Town of Barnstable Barnstable ' r NAM ' Board of Health 639 ��� Arlo'' 200 Main Street, Hyannis MA 02601 2007 Office: 508-8624644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi November 26, 2012 Ms. Alena Kadolka 8 Thoreau Drive Centerville, MA 02632 8 Thoreau-Drive, Centerville Dear Ms. Kadolka, During the public meeting of the Board of Health held on July 10, 2012, the Board voted to post the premises located at 8 Thoreau Drive, Centerville, as "Unfit for Habitation." You, the owner, failed to repair the hydraulically failed septic system as ordered. The septic system originally failed during an inspection conducted by Robert Paolini on February 20, 2009. The leaching pit was full of sewage up into the risers, indicating that the soil absorption system was in hydraulic failure. According to the Board of Health Regulation, a hydraulically failed septic system shall be repaired or replaced within sixty (60) days. Also it was discovered on March 31, 2009, after a complaint was received, that there were too many bedrooms in the dwelling and within the basement for the existing septic system to handle. According to your response letter dated May 18, 2009, you stated that you will be upgrading the septic system to accommodate four bedrooms. However, to date the septic system has not been repaired or replaced. Several order letters were mailed to you directing you to repair the failed septic system via certified mail including letters dated September 30, 2011, October 3, 2011, and May 24, 2012. On March 7, 2012, an order letter was posted onto your front door at 8 Thoreau Drive, Centerville. In addition, on April 21, 2012, Deputy Sheriff Brad Parker delivered the order letter to you at 10:15 a.m. To date the septic system has not been repaired. This property is deemed Unfit for Habitation. You are ordered to vacate the premises within twenty-four hours of your receipt of this letter. The premises shall remain unoccupied until such time the septic system is repaired or replaced. PE ORDER O HE BOARD OF HEALTH 'Viayn filler, M.D., Chairman Q:\WPFI ES\FailedS ystemBeyondDeadlineThoreauDrive2012.doe 8 Thore�Ai Dr Gent Page 1 of 1 Crocker, Sharon From: McKean, Thomas Sent: Thursday, December 13, 2012 3:18 PM To: Crocker, Sharon Subject: Re: 8 Thoreau Dr Cent No I would place it into the file with a note indicating its being repaired today 12/13/2012. On Dec 13, 2012, at 3:14 PM, "Crocker, Sharon" <sharon.crocker(a,town.barnstable.ma.us> wrote: Tom, The owner had B&B Excavating pull a septic permit on Monday 12/10/12. Do you still.want me to send out the letter out? Sharon 12/13/2012 OF'i i, �lic� ks�tncir OdAl QOeS awn V�h.c hause,— Ne b��1�1 (n die p S��s ht�,ruua (Our� kv), i °F,►+E rosy Town of Barnstable °^ Regulatory Services + BARN STABLE, 9 MASS. Thomas F. Geller, Director Consumer Affairs Division 200 Main Street, Hyannis MA 02601 Tel:508-862-4668 Fax:508-778-2412 Kadolka, Aliaksandr Notice Date: 07/29/2009 606 Old Stage Road �� I� BAR No: 79997 Centerville MA 02632 o J (� _ Fine: 100.00 Balance Due: 100.00 Please return this section with your payment _ _ _ _ FINAL NOTICE Be advised that full payment has not been received for the fine issued against you on 05/26/2009 for a violation of the Town of Barnstable Ordinance or Regulation as described below: Violation of Chapter 170: RENTAL PROPERTY - 4 Certificate of Registration No person shall refit or lease or offer to rent or lease any dwelling or any Bar No: Violation Date: Enforcing Department: Location of Offense: 79997 05/26/2009 Public Health 8 Thoreau Hyannis_ Fine: Payments: Balance Due: 100.00 0.00 100.00 You are hereby notified that if you fail to pay the fine in full within 7 days from the date of this notice, that a CRIMINAL COMPLAINT WILL BE ISSUED against you I Fines may be paid by appearing in person between 8:30 AM and 4:00 PM, Monday through Friday, except legal holidays, before : The Barnstable Clerk 200 Main Street, Hyannis MA 02601 OR by mailing a check, money order, or postal note payable to: Barnstable Clerk P 0 Box 2430 Hyannis, MA 02601 This will operate as a final disposition of the matter with no resulting criminal record. I QUITCLAIM DEED I, Patricia R. DeOliveira, being unmarried, of Centerville, MA, For consideration paid in the amount of TWO HUNDRED THOUSAND & 00/100 ($200,000.00) DOLLARS MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date; 03-13-200 & 03:3Epm - Grant to Ct 14 e 1330 Doc' 13162 Fee. $684.00 Cons: $20i i r itfj0.00 Alena A. Kadolka of 606 Old Stage Road, Centerville, MA, 02632, WITH QUITCLAIM COVENANTS The land with the buildings and improvements thereon situated at 8 Thoreau Drive, Centerville, Barnstable County, Massachusetts shown as LOT 4 on a plan entitled "Subdivision Plan in Centerville, Barnstable, for Alan E. Small" drawn by Charles N. Savery, Inc., dated February 12, 1973, recorded in the Barnstable Deeds Plan Book 272, Page 58, and being more particularly bounded and described as follows: NORTHWESTERLY by Thoreau Drive, by a line and a curve measuring One hundred sixty-four.and 93/100 (164.93) feet; EASTERLY by Centerville-West Barnstable Road (Old Stage Road), ninety-eight and 56/100 (98.56) feet; SOUTHERLY by Lot 5 on plan hereinabove mentioned, one hundred Fifty and 00/100 (150.00) feet; WESTERLY by a portion of Lot 9 on said plan, eighty-two and 79/100 (82.79) feet. Containing 15,625 square feet, more of less. - Subject to and together with all rights, easements, restrictions and reservations of record insofar as the same are in force and applicable. BARNLiTABLE COUNTY E. `CISE TA: BARN=-i'r�BLE `OUN-aY tE *TS RY OF DE.EDO For title see deed recorded in Book 22449, Page 270. (}-1 i.-K"C, ur .i 131..62 WITNESS my hand and seal this ., day of March, 2009. t i ' Ti�eOliveira p Barnstable, ss: On thisW y of March, 2009, before me, the undersigned notary public, personally appeared Patricia R. DeOliveira, and proved to me through satisfactory evidence of identification, being (check whichever applies): other state or federal governmental document bearing a photograph image; ❑ Oath or affirmation of a credible witness known to me who knows the above signatory, or ❑ My own personal knowledge of the identity of the signatory,to be the person whose name is listed above, and acknowledges to me that he/she/they signed the foregoing instrument voluntarily for its stated purpose. ram.. _='��� N J. 0! v Pu lic �•. . My Commission Expires: (SEAL) � PU6��C= BARNSTABLE REGISTRY OF DEEDS . • (DomesticCERTIFIED T'� ILfRECEIPT Only; For delivery information visit our website at www.usps.comg ul ruin =I- Postage $ wA OCertified Fee Return Re*'Pt Fee Postmark O (Endorsement Required) Here ! O Restricted(Endorsement Fee p- m n Required) J�N26 ZD zr M Total Postage&Fees $rq a -- - US '- Ms Alena Kadolka 8 Thoreau Drive Centerville, MA 02632 t Certified Mail Provides: ya A mailing receipt t is A unique identifier for your mailpiece ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mailp or Priority Mail®. r Certified Mail is not available for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a LISPS®postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". ■ If a postmark on the Certified Mail receipt is desired,please present the art! cle at the post office for postmarking. If a postmark on the Certified Mail. receipt is not needed,detach and affix label with postage and mail. -- IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,August 2006(Reverse)PSN 7530-02-000.9047 I °F zKKE r�,y Town of Barnstable Barnstable Board of Health j aieaC j ""RM�B1�'$ 200 Main Street, Hyannis MA 02601 D Dm 1639. 2007 �Arf0 MAC a, Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7011 0470 0001 4525 7246 June 25, 2012 Ms Alena Kadolka 8 Thoreau Drive Centerville, MA 02632 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday July loth at 3pm in the Town Hall, Hearing Room, 2nd floor, 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 8 Thoreau Drive, Centerville The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the leaching pit was full at time of inspection. And, there was no backup observed in d-box because line to pit was piped into risers. We have tried to reach you several times since September of 2011, with no results At one point we asked you to appear before the Board of Health on September 11 th 2011 in order to resolve this situation, You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE OARD OF HEALTH T omas McKean, R. 'S. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 Thoreau Dr.,Cent.doc t. Op\NEJ .V'�o Barnstable U.S.POSTAGE>>PITNEY BOWES Public Health Divisiona`� BARN NE i 200 Main Street ®G� °39•° Hyannis,MA 02601 ZIP 02601 f Q �EOMr•+ $ 005.75 I0001361475 JUN. 26. 2012 7011 2470 0001 4 6 525 7246 RETURN RECEIPT REQUESTED Ms. Alena A. Kadolka 8 Thoreau Drive r YJL- Centerville, i xi E 02 9 .< 9 E is 2's. RETURN TO S'ENtDER ATTE141PTED NOT KNOWN t5i iJGt)t3i�€41LIL1A13 � L 84-0!:134—'26-44 02 il�;llilll�31�i3� 11611111�31�8�S37S1ii11fi11118t199id1111I1� . ti I � SENDER: COMPLETE THIS SECTION COMPLETE THIS SECTIONON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature - I item 4 if Restricted Delivery is desired. ❑Agent X 1 ■ Print your name and address on the reverse ❑Addressee , I so that we can return the card to you. B. Received by(Printed Name) C. Date of Delivery I ■ Attach this card to the back of the mailpiece, I I or on the front if space permits. I D. Is delivery address different from item 17 Oyes 1. Article Addressed to: If YES,enter delivery address below: ❑ No Ms Alena Kadolka I 8 Thoreau Drive I 'Centerville, MA 02632 3. Service Type I Certified Mail 1.3,Express Mail ❑ Registered ❑ Return Receipt for Merchandise I ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes I I 2. Article Number r 7 011 0470 0001 4525 7246 I (Transfer from service label) I }' j( PS Form-3811,February 2004 Domestic Return Receipt 102595-02-M-1540 4 f Town of Barnstable Barnstable SHF To,,ti Board of Health ;edcaC i *9 nA MASS.LE, Q` 200 Main Street, Hyannis MA 02601 0 8 p D MASS. 0 1639. �m prf 2b µ 007AI> Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL #7011 0470 0001 4525 7246 June 25, 2012 Ms Alena Kadolka 8 Thoreau Drive Centerville, MA 02632 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD on Tuesday July • 10th at 3pm in the Town Hall, Hearing Room, 2nd floor, 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 8 Thoreau Drive, Centerville The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more stringent deadlines dependent upon the type of failure identified. In this case, the leaching pit was full at time of inspection. And, there was no backup observed in d-box because line to pit was piped into risers. We have tried to reach you several times since September of 2011, with no results At one point we asked you to appear before the Board of Health on September 1 lth 2011 in order to resolve this situation, You will be given the opportunity to testify, present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R. W. CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 Thoreau Dr.,Cent.doc • THE Town of Barnstable Barnstable lit Regulatory Services Department ADAmeiica�y 0311 BARNSCABLE.)• m MASS. Public Health Division - �Z �p 9. �0 lFD"'"` 200 Main Street, Hyannis MA 02601 7007 / Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO May 24, 2012 Ms. Alena A. Kadolka 8 Thoreau Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at, 8 Thoreau Drive, Centerville, MA, was last inspected on 2/20/2012 by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines Y Y of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. • No backup observed in d-box because line to pit was piped into risers. We have tried to reach you several times since September of 2011, with no results. At one point we asked you to appear before the Board of Health 10/11/2011 in order to resolve this situation. We would like to resolve this problem as quickly as possible. Therefore you are ordered to repair or replace the septic system within thirty (30) days from the date you receive this notification. Please contact this office (508 862 4644) immediately to inform us what steps are being taken to resolve this issue. I . Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO RD OF HEALTH Tho c ea , S. CHO gent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 Thoreau Dr.,Cent..doc Li Town of Barnstable Barnstable THE Tp�y Regulatory Services Department ix'ca�y (96A MASABLE,�039. public Health Division MASS ArED MAt a 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 'May 24, 2012 Ms. Alena A. Kadolka 8 Thoreau Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at, 8 Thoreau Drive, Centerville, MA, was last inspected on 212012112 by Robert Paolini, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. • No backup observed in d-box because line to pit was piped into risers. We have tried to reach you several times since September of 2011, with no results. At one point we asked you to appear before the Board of Health 10/11/2011 in order to resolve this situation. We would like to resolve this problem as quickly as possible. Therefore you are ordered to repair or replace the septic system within thirty (30) days from the date you receive this notification. Please contact this office (508 862 4644) immediately to inform us what steps are being taken to resolve this issue. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO RD OF HEALTH Tho c ea , S. CHO gent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 Thoreau Dr.,Cent..doc L Town of Barnstable Barnstable pf SHE Tp� kzftd Regulatory Services Department I e1C8C j RARYSTABLE. • J. Q MASS i q. Public Health Division vp 63 �0 RFD MAt a 200 Main Street, Hyannis MA 02601 20°� Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 18, 2012 Final Order Ms. Alena A. Kadolka 8 Thoreau Drive Centerville MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Thoreau Dr., Centerville,MA was last inspected on 2/20/09, by Robert Paolini, a certified septic inspector for the Sate of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. No backup observed in d-box because line to pit was piped into risers. 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 with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH 60 Thomas McKean, R.S., CHO. Chairman Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 thoreau Dr hand delivered.doc 1, http://www.whitepages.com/name/Alena-A-Kadolka/Centery i l le-MA/5cpapeu WhitePages Alena A Kadolka 8 Thoreau Dr Centerville, MA 02632-2212 Claim It! >> Are you Alena? Edit your info. Connect with your neighbors. J,. -c 2 hlitrb6ft'Curporatibrn U mw-r'ct2 G M D 1� http://www.whitepages.com/name/Alena-A-Kadolka/Centerville-MA/5cpapeu 4/10/2012 i l r. Town of Barnstable Barnstable /OF SSHE Tp AD-AmmieaC" Regulatory Services Department I BARNSfABLE, ' - - m imZs. m Public Health Division �A 1639. 2007 rfp MFt a' 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Gei]er,Director FAX: 508-790-6304 Thomas A.McKean,CHO Posted to door fOfWU" �� 2 March 7, 2012 Hand delivered Ms. Alena A. Kadolka 8 Thoreau-Drive Centerville MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 system located at 8 Thoreau Dr. Osterville MA was last The septic sys inspected on 2/20/09,by Robert Paolini, a certified septic inspector for the Sate of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. No backup observed in d-box because line to pit was piped in is-er-s, You are ordered to repair or replace the septic system within sixty (60) days om the date you receive this notification. I Failure to repair/replace the septic system with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH j � I (( ,, i ean, R.S., CHO. 4' Chairman Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 thoreau Dr hand delivered.doc 'ny Town of Barnstable Barnstable �Op SHE�p tiP �y� Regulatory Services Department e'caC 1 li IARNS'rABLE, T MASS. �A Public Health Division 039. �� ArEb MAt a 2007 200 Main Street, Hyannis MA 02601 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL # 7011 0470 0001 4525 5334 October 3, 2011 Ms. Alena A. Kadolka 8 Thoreau Drive Cneterville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic s tern located at 8 Thoreau Dr., Ostervillec , MA was last inspected on p Y . p 2/20/09, by Robert Paolini, a certified septic inspector for the Sate of Massachusetts. The inspection of the septic system showed that the system "Fails"under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. No backup observed in d-box because line to pit was piped into risers. 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 with the deadline period will result in future enforcement action. PER ORDER OF THE BOARD OF HEALTH Thomas McKean, R.S., CHO. Chairman Documentl I_ USPS.com®-Track&Confirm https:Htools.usps.com/go/TrackConfirmAction.action x English Customer Service USPS Mobile Register I Sign In USPSArdilli . 1VillSearch USPS_cnm or Track Packages Quick Tools Ship a Package Send Mail Manage Your Mai! Shop Business Solutions i Track & Confirm You entered:70110470000145255334 Status:Delivered Your item was delivered at 11:13 am on October 24,2011 in HYANNIS,MA 02601. Additional information for this item is stored in files offline. You may request that the additional information be retrieved from the archives,and that we send you an e-mail when this retrieval is complete.Requests to retrieve additional information are generally processed within four hours.This information will remain online for 30 days. I would like to receive notification on this request Restore Find Another Item What's your label(or receipt)number? Find LEGAL ON USPS.COM ON ABOUT.USPS.COM OTHER USPS SITES Privacy Policy r Government Seiyic(is i About LISPS Home> Business Ctstomer Gateway) Terms et Use, Buy Stamps&Shop� NcWsroom r Postal Inspoctors FOIA, Pent a LabePwith Postage> Mail Seivim.Updaics, Inspector General No FEAR Act EEO Data r Customer Service; Forms&Publirations, Postal Lxplorer Site Index r Careers Copyrights i 2012 LISPS.All Rights Reserved https:Htools.usps.com/go/TrackConfirmAction.action 4/24/2012 SHF Town of Barnstable Barnstable rOh� Regulatory Services Department mica �IIAFt159. E,o! public Health Division MASS. 0 O° t6Sq, `� prED MAt a. 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO 'May 24, 2012 Ms. Alena A. Kadolka 8 Thoreau Drive Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, Title 5. The septic system located at, 8 Thoreau Drive, Centerville, MA, was last inspected on 2/20/2012 by Robert Paolini, a certified septic inspector for the State of Massachusetts. i The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. • No backup observed in d-box because line to pit was piped into risers. We have tried to reach you several times since September of 2011, with no results. At one point we asked you to appear before the Board of Health 10/11/2011 in order to resolve this situation. We would like to resolve this problem as quickly as possible. Therefore you are ordered to repair or replace the septic system within thirty (30) days from the date you receive this notification. Please contact this office (508 862 4644) immediately to inform us what steps are being taken to resolve this issue. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF THE BO OF HEALTH i Tho c�e S. CHO gent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 Thoreau Dr.,Cent..doc I Town of Barnstable Barnstable °FSKE A ftwicaCity Regulatory Services Department + UAftNSTABLE, •I • MASS. 9� Public Health Division A i639' `0 2007 'ED M a 200 Main Street, Hyannis MA 02601 1 Office: 508-862-4644 Thomas F.Geiler,Director FAX: 508-790-6304 Thomas A.McKean,CHO April 18, 2012 Final Order Ms. Alena A. Kadolka 8 Thoreau Drive Centerville MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 8 Thoreau Dr., Centerville,MA was last inspected on 2/20/09, by Robert Paolini, a certified septic inspector for the Sate of Massachusetts. The inspection of the septic system showed that the system "Fails" under the guidelines of the 1995 TITLE 5 (310 CMR 15.00) due to the following: • Leaching pit was full up into risers at time of inspection. No backup observed in d-box because line to pit was piped into risers. 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 with the deadline period will result in future enforcement action. PER ORDER OF THEE RD OF HEALTH ean, R.S. ISO. Chairman Q:\SEPTIC\Letters Septic Inspection Failures or Future Eval\8 thoreau Dr hand delivered.doc Barnstable County Sheriff's Office I hereby certify and return that on April 21, 2012 at 10:15am I served a true and attested copy of the within Letter, by leaving for the within named Defendant: Alena A. Kadolka, at the last and usual address of: 8 Thoreau Drive, Centerville, MA 02632, and by mailing 1 st class to the Defendant at the stated address on the same day. Fee: $45.00 D Brad Parker, treputy Sheriff PO Box 614 Centerville, MA 02632 t The Commonwealth of Massachusetts Please remit to:,, DEPUTY SHERIFF BRAD PARKER P.O. Box 614 Barnstable County Centerville, MA 02632 Off.508-362-9578/Cell 508-776-3238 r # 48 File No. 11�7 April 21 2012 To Law Offices of Di blip Health division -Town Of Barnstable For Service of Writ Letter - n a hl d Of uoalth vs. Alena A Kadolka Service $45.00 Paid Witness Fee Travel Poundage Conveyance Special Service Postage, etc. Postal Search Copies D/S Office Fee Capias Hourly Mass. Fee TOTAL DUE: $ 45.00,- PAYABLE UPON R PLEASE PAY FROM THIS INVOICE. ORIGINAL WRIT RETURNED ❑TO COURT HEREWITH New address of defendant: PLEASE RETURN YELLOW COPY WITH PAYMENT.......THANK YOU. . i Town of Barnstable. P# � Department of Regulatory Services Public Health Division Bate mutmrrAiBm NAVa s6Jy. tee$ 200 Main Street,Hyannis MA 02601 �iED►Ali ��. C J Date Scheduled Time Fee Pd., I ,So ,Suitability A;ssessr nt*fop �'e • e Disposal Performed By: \" P r Witnessed By: LOCATION & GENERAL INFORMATION Location Address'. b Owner's Name je A loo , Address Assessor's.Map/P4rcel: y Iq 1 �t "-7 0 I Engineer's Name NEW CONSi`RUt,ON t l REPAIR Telephone# --mod� Land Use ref'� 1� f t. Slopes(4'0) 6" Y'! y �' Surface Stones l 'a ✓ Distances from: Open Water Body � - ft Possible WePArea 74 6 ft Drinking Water Well r f[ Drainage Way � ft Property Line 7!L ft Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&perc tests,locate wetlands in proximity to holes) R<JOo s C` h 3 a CATCH BASIN ELU-52.7 CATCH BASIL 23SA6; -._5 OXE 52.] ce o \ - 3-BEDROOM DWELLING TOF= - - �O,O �J•\\01 \ i _ 1 -- 55.0 cls± \ • � 118•,�IPE .P.) • WNL LOT 4 AREA-15.625t S.F. 150.DD ,8,22:36"E LOT 5 i I evclyvr 1 Parent material(geologic) e Depth to Bedrock t - 4 Depth to Groundwa(;er-. Standing Water in Hole: ry �1 I Weeping from Pit Face `� t`— Estimated Seasonal High Groundwater i A 4 DtTERMINATION FOR SEASONAL EaGH WATER T"LE Method Used: I In, Depth 00perved standing in obs.hole: in. Depth to Sall mottles: $. Depth toiweeping from side of obs.hole: ! in. ©rdundwnter AdJuetmt nt Index Well# Reading Date: Index Well levdl Adj.f:►etor AdJ,(roundwater Level— PERCOLATION � I PERCOLATION TEST .=�.,.e. Observation Time at 9" --� Hole# Time at G" Depth of Pere t Time(9"-6") Start Pre-soak Time.@ � I --- i End Pre-soak Rate MinJlnch Passed Site Failed: Additional Testing Needed(Y/N) Site Suitability Assessment Site Original:.Public x= lth Division Observation Hole Data To Be Completed on Back— ***If percolalyit)n testis prior to beginning. to be condlacted within 1.00' of wetland,you must first notify the Barnstable Conservation Division at least one.(1) wedk DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other .Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. onsistenc %Gravel ls'8,'�4✓f,I JA DEEP OBSERVATION HOLE LOG Hole# � Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel) 'l der q 30 -f DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Hor` Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistenc %Gravel DEEP QBSERVATION HOLE LOG Hole# I Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones.Boulders. Consisten Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No— Yes Within 500 year boundary No Yes �. Within 100 year flood bounds No Yes Y boundary — Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist,in all areas observed throughout the area proposed for the soil absorption system? " -� 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 Enviro 'mental Protection and that the above analysis was performed by me consistent with the require tram' g eI xper is d experience described in 3:10 CMR 15.017. MW Signature ` Date Q:\SEPTIC\PERCFORM.DOC down cape engineering, inc. SIEVE SOILS ANALYSIS 8 THOREAU DRIVE CENTERVILLE, MA DATE OF REPORT:1/4/12 .JOB : GRAIN SIZE ANALYSIS-SIEVE TEST SITE: 8 THOREAU DRIVE CENTERVILLE, MA LOCATION: DARREN MEYER TESTHOLE � / /►i SIEVE ANALYSIS Weight Sample(Grams): 262.7 SIZE ;WEIGHT RETAINED % RETAINED % PASSED -------------- -•--- (sum)-----...-•-- q------------------o .... o 1 0.0: 0.0%: 100.0% ------------ ---.•••---••--------••--- 1---------------------�------------------ -------------- -----------------•--------A---------------------•------------------ 1/2" 0.0;_ / 0.0%: --100.0% -----------------------.------- ---------------- ----------- ----- - -- ---- --------. -#4 0.-0:--- 100 ------------- - 0%---------- :0% #10 39.1: 14.9%: 85.1% --------------� --a--------------------------------- - #20 -------------------142.2•t-------------54_1%� 45:9% ------------- --...._ #50 '------------------------------------------------; --....7_3% #80-------- 254.9: 97.0%: - 3.0% -------------------------------------------------------- --- #100 : 256.1a-------------97 5%: 2.5% -------------- ------------------ ----------------- #200 257.9: 98.2%: 1 8% PAN: ; 260.3; 100.0%r - 0 0% --------------r--------_---__------262.2.7: - _-----------------------------------------_ SAMPLE: NOTE:TEST ON PASSING#4 ONLY, 28.4% RETAINED ON#4 <45% O.K. RESULTS: SOIL CLASSIFIED AS AASHTO A-3 (GRANULAR, COARSE SAND)(UNCOMPACTED) PERCENTAGE OF MATERIAL PASSING#4 SIEVE : #4 100% (TEST ONLY MATERIAL PASSING#4) OK #50 10%-100% 7%SLIGHTLY TOO COARSE #100 0%-20% OK #200 0%-5% OK SAMPLE CLOSE TO MEETING TITLE 5 FILL SPECIFICATION >98% SAND s RESULTS: PERMEABLE MATERIAL-CLASS 1<2 MINJIN. MATERIAL orFdgss9c NONCOMPACTED � DANIELA. yam SOIL DESCRIPTION: SAND T o OJALA CIVIL No.46502 � o E 1 •- ``, ,b AL C Postal CERTIFIED P4-AIL,,,v�RECEIPT m . • . !Lr) For delivery information visit our website at www.usps.como Ln `!ru Postage $ tS� CO CertHied Fee i�]� Return Receipt Feemark 4� �v14 O (Endorsement Required) HQ p ResMoted DelUrery Fee r (Endoreement Required) 0 Total Postage&Fees $ 5.5 rR Sent o or PO Box No. r_ !�._ Th �_..... - City Sete.------- �- --.l.1 L__.. L C17eeA- �� 117A i Certified Mail Provides: ■ A mailing receipt ■ A unique Identifier for your mailpiece ' ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Mail®or Priority Mail®. ■ Certified Mail is notavailable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail ■ 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 USPSO postmark on your Certified Mail receipt is' required. ■ 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". ■ 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 Hof IKE T� Town of Barnstable Barnstable ti o MftedcaCily Board of Health BA RNS'rABLE M , 9 ASS. $ 200 Main Street, Hyannis MA 02601 c� i0g9, ♦� y prfb MAI s 2007 Office: 508-862-4644 Wayne Miller,M.D. FAX: 508-790-6304 Paul Canniff,D.M.D. Junichi Sawayanagi CERTIFIED MAIL # 70110470 0001 4525 5341 September 30, 2011 Ms. Alena A. Kadolka 8 Thoreau Drive Centerville, MA 02632 YOU ARE SCHEDULED TO APPEAR BEFORE THE BOARD OF HEALTH on Tuesday, October 11, 2011 at 3pm in the Town Hall, Hearing Room, 2nd Floor, 367 Main Street, Hyannis, MA due to your failure to repair or replace the failed septic system at 8 Thoreau Drive, Centerville, MA 02632 The State Environmental Code Title V requires all failed septic systems to be repaired or replaced within two years. The Town of Barnstable Board of Health has more Stringent • deadlines dependent upon the type of failure identified. In this case, the septic system has been in failure beyond the established deadline. You will be given the opportunity to testify,present witnesses, documentary evidence, and other official information regarding this case. PER ORDER OF THE BOARD OF HEALTH Wayne Miller, M.D. Chairman Q:\SEPTIC\Letters Septic Inspection Failures\1567 Race Ln.,MM.doc NAME OF OFFENSE - DAD 9997 TOWN OF ADDRESS OF OFFENDER D �]irry 4 ±� A 1 Dnn BARNSTABLE CITY,STATE,Z1 ODE • `�+/� ° �'•`•+ 1/WyG, dot SINE IN, MV/MB REGISTRATION NUMBER OFFENSE • , W ) fJ BARNSTABLE• tt i' r `yy� ..�, MASS. Uf<°- 7 O n. I-to { w tA � E OF VIOLATION LOCATION OF VIOLATI Z NOTICE OF # (A.M./P. i ON 06 ,20 441 �+ �" v r '1 •� w'rtl SIGN,�jItRbOFENFORCIN PERSON N I DEPTH BADGE NO. N VIOLATION � � Jry ( V o OF TOWN I H�Ff EBY ACKNOWLEDGE RECEIPT OF CITATION X a ORDINANCE ® Unable to obtain signature of offender. M. H NONC N F S OFFENSE IS i cro Date mailed Iw OR YOU HAVE THE FOLLOWING ALTERNATIVES WITH REGARD TO D OSITION OF HIS MAT R.EITHE OPTIO (1)OR OPTION(2)WILL OPERATE AS A FINAL a DISPOSITION WITH NO RESULTING CRIMINAL RECORD.earing y y p N REGULATION beforeu The Barnstable stabct to le Cle k,the 2000 Meiove n Street,H either yannis,MA 02601,or by mailing g a check,money order o postal note to Barnstable Clark,P.OBBox 2430, Hyannis,MA 02601,WITHIN TWENTY-ONE(21)DAYS OF THE DATE OF THIS NOTICE. a UNSTABLE you desire to contest this matter in a noncriminal proceeding,you mey do so by making written request to DISTRICT COURT DEPARTMENT,FIRST UNSTABLE DIVISION,COURT COMPOUND,MAIN STREET,BARNSTABLE,MA 02630,Attn:21D Noncriminal Hearings and enclose a copy of this citation for a hearing. 't L (3)If you fail to pay the above.offense or to request a hearing within 21 days,or If you fall to appear for the hearing or to pay any fine determined at the 74 hearing to be due,criminal complaint may be Issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense charged,and enclose payment in the amount of$ Signature i SC�DE�-.��MPL�ETETHIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ C X'Complete;--items 1,2,and 3.Also complete A. Signatu item 4 if Restricted Delivery Is desired. ❑Agent ■ Print your name and address on the reverse1W ❑Addressee so that we can return the card to you. B. Received b ri ted Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, I� or on the front if space permits. I 1. Article Addressed to: D. Is delivery address different from Item 1? ❑Yes enter delivery address below:r ❑No 6 �6 D �, 3. Service Type ; �eRlfied Mail El aoress Mail ❑RegisteredReceip"t`for'AAerchandise ❑Insured Mail ❑C. D, 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number j 7 081 y830 D002 0:500, 8.0-0; � (Transfer from service label) PS Foam 3811 February, qN Domestic Return Receipt 102595-02W-1540 UNITED STATES POSTAL SERVICE First-Glas.-Mail *,M to FeesPaid 1',k i.•:: t"� is .y o tip... �.� v ,6�tmtmit No 43 m,,,, uPl Y.'.• ;t�si''i.. .:;f',u.,,., 1' €`� ••_ _ • Sender: Please print your name, address ' ncl` 1P+ w,., ""e. In.tMi �o�t'• _ Town of Barnstable �Ox Health.Division 200 Main Street ! Hyannis,MA 02601 111.. 1,1,11�111111m1111t►11i,„ l,, 111;111,,,11811111111 Certified Mail#7008 100 0062 0500 8055' rt ram` Town of Barnstable y .b Regulatory Services RA, STABLE, 9� bz .gig Thomas F. Geiler,Director Public Health Division Thomas McKean,Director 200 Main Street, Hyannis, MA 02601 Office: 508-862-4644 Fax: 508-790-6304 0 1 ' April 7, 2009 Aliaksandr Kadolka 85 Cottonwood Lane Centerville, MA 026312 NOTICE TO ABATE VIOLATIONS OF 105 CMR 410.000, STATE SANITARY CODE II—MINIMUM STANDARDS OF FITNESS FOR HUMAN HABITATION. The property owned by you located at 8 Thoreau Drive, Centerville was inspected on March 31, 2009 by Timothy O'Connell, R.S., Health Inspector for the Town of Barnstable. This inspection was conducted on the basis of a complaint. The following violations of the State Sanitary Code were observed: 105 CMR 410.450—Means of Egress. A room was observed being used as a bedroom within basement of home without proper second means of egress as required by 780 CMR 3603.10.4.1of the Mass State Building Code. 105 CMR 410.300 and 310,CMR 15.00: There were a total of four (4) bedrooms observed in this dwelling. However, the existing septic system (permit# 89-349) was not designed for(4) four bedrooms. It was designed for three (3) bedrooms. The following violation of the Town of Barnstable Code was observed: § 170-4 Certificate of Registration: Rental property is not registered with Town of Barnstable of Health Division. § 353-1 Responsibilities of Owners: Observed large amount of paint cans and other debris at property. J� QAOrder lettersMousing violations\8 thoreau.doc You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by ceasing and desisting the use of said room within the basement as a bedroom. You1re also ordered to remove beds from said room. You are ordered to remove the bedroom from the basement by removing entrance door and by opening the door-way entrance to a minimum of five feet wide opening this must be complete with thirty (30) days of your receipt of this notice. You are directed to correct the violations listed above within twenty-four (24) hours of your receipt of this notice by removing all paint cans and other debris from property and properly disposing of it. You are also directed to register property with Health Division within fourteen (14) days of your receipt of this letter. You may request a hearing before the Board of Health if written petition requesting same is received within ten (10) days after the date the order is served. Non-compliance will result in a fine of $100.00 per violation. Each day's failure to comply with an order shall constitute a separate violation. Should you have any questions regarding the above violations, please contact the Town Health Division and ask to speak with the inspector who performed the inspection. PER ORDER OFT E BOARD OF HEALTH T omas A. McKean, R.S., CHO Director of Public Health Town of Barnstable Cc: Timothy O'Connell, R.S., Health Inspector QAOrder letters\Housing violations\8 thoreau.doc 05/18/2009 Alena Kadolka 606 Old Stage Rd Centerville, MA To Whom It May Concern: In response to your letter regarding the health violations at the property I recently bought at 8 Thoreau Dr. I wanted to inform you that: 1- When I bought this house in the short-sale (pre-foreclosure) I did not know I would have to honor an outstanding lease. They are having a difficult time fmding a new place to rent that attends their needs. Since they have a child I can not simply evict them; 2- Therefore, I am upgrading the septic system to accommodate 4 bedrooms; 3- The basement currently has more than one "Egress" consisting of a door to the outside, 2 full size windows; 4- The paint cans/debris have been completely removed from the yard; I am actively trying to bring the house to compliance so I can keep the current renters without any issues. Gitizen Web Request Page 1 of 3 Y 1 yy,,...w,z�.r„e....:.�.a„ Citizen Request ,$j§ e_4{WN\ c lid. be q u�r s Management � C; {.' x'; ..��±,1�1J�+v;1.iLC1C1IlE,'.i�.� a �.. t.v?i;tc'. to L%Se':t'S SE:c'.'':"' i,..T�E:?:'i:' kCe't c,..`:5 Request Information ................................._25066 .............. ._.. ...._._._.___.. ..Y�.. .. .... . _ ._ _.._ ..._... ...... ......_..._.............. Request Status: Assigned To Staff Assigned To: O'Connell, Timothy Health Office Anonymous: Yes Request Category: Section 353-1 Garbage and Rubbish Routine work: No Estimate: No Date scheduled: Estimated 4/13/2009 Change Estimated Mar April 2009 Mav Completion Completion Date: Date: Sun Mon Tue Wed Thu Fri Sat 29 30 31 1 2 3 4 5 5 6 7 8 9 1011 12 3 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 1 9 Created By: Parvi�pdsay Priority: Medium Head... ;office Citation Numbers: �y Requestor Information -- _- _.__................._.__..._.._.........__..............-..._..._..........................._......................_......_._._....__...................................___......_..---.................._...._......._.._._......._._.......__.._..._..............__...._.._._.....---........_..__..._............_...... Requestor Request DETAILS: LOCATION: 8 THOREAU DRIVE Centerville, Ma 02632 Request Parcel Number Requestor reports a large dump Map: :000 ` Block: �000 Lot: 0( truck has been parked on the side of the residence for several days. Parcel..Lookup Requestor reports several cars parked outside residence and suspects that it is a rental. http://issgl2/intemalwrs/WRequest.aspx?ID=25066 4/7/2009 Citizen Web Request Page 2 of 3 Email: Edit Requester Information Track Request Progress —Request Work History: -Internal Note History: Entered on 4/2/2009 9:26:06 AM System entry on 3/30/2009 10:56:53 AM: by O'Connell,Timothy Assigned to O'Connell, Timothy On 3-31-09 went to said property. I did not observe a dump truck but did observe a large amount of used paint cans. I also talked with tenants. They told me five adults live at said property.There are 3 bedrooms on main floor with a 4th in the basement. The basement is set up as an efficiency apt. I have briefed R Anderson from zoning. Will send out order to reg. and told pick up paint cans. update delete Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) ;Spell Check �;� Spe[I Check��- ((tE ;P E I -Add document or image link: "BrowSe� - You can also type in a folder name to see everything in the folder Current Links: Time worked on request: 4.00 Response time: 2.00 http://issgl2/intemalwrs/WRequest.aspx?ID=25066 4/7/2009 .Vealth Master Detail Page 1 of 1 y/ <E$L3cc rd I n!,s: J WNkc ronneit k..rwli..�,r day Aa Health Master t A piicat on Center Parcel Lookup SE!(;:,':i 01 ltentns Parcel Septic: Perc Sell Fuel Tank Parcel: 191-170 Location: 8 THOREAL! DRIVE, CENTERVIL.L.E Owner: DE OLIVE IRA, PATRICIA R Business name: . Business phone Rental property: Deed restricted: Number of bedrooms Contaminant released: Fuel storage tank permit: _. Save Parcel Changes Return to Lookup Parcel Info Parcel ID: 191-170 Developer lot:LOT 4 Location:8 THOREAU DRIVE Primary frontage: 130 Secondary road:OLD STAGE ROAD Secondary frontage: 1.20 Village:CENTERVILLE Fire district:C-O-M M Sewer acct: Road index: 171.3 Asbuilt Septic Scan: 101170 1 Interactive map Town zone of contribution:AP (,aquifer Protection Overlay District) State zone of contribution:OU f Omer Info Owner: DE OLIVE:IRA, PATRICIA R Co-owner:;"oKADOLKA, ALENA A Streetl:606 OLD STAGE ROAD Street2: City:CENT ERVILLE State:MA Zip: 02632 Countr Deed date: 11./2/2007 Deed reference:22.449/270 Land Info Acres: 0.:36 Use: Single Fern MDL-01 Zoning:RC Neighborhood: 0105 Topography:Level Road:Paved Utilities: Public Water,Gas,Septic Location: Construction Info+4u:kiin r yClar Built rNe tive Ann;j iedreu=3 n BatkiwU r.s 1 1989 1833 3 Bedrooms 3 Full Buildings value: $166,700.00 Extra features: S13,800,00 Land value: $ 42,500.00 http://Issgl/Intranet/healthMaster/HealthMasterDetail.aspx?ID=l 91170 4/7/2009 I` Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 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. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Robert Paolini cursor-do not Name of Inspector use the return key. Capewide Enterprises,LLC. Company Name P.O.Box 763 Company Address Centerville Ma. 02632 City/Town State Zip Code (508)428-4028 S14454 Telephone Number License Number s 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 2/20/2009 Inspe or's Sin re Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system 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. L 3 O t5ins•OkEl Title 5 Official Inspection Form:Subsurface Sewage Dis osal System•Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form • Not for Voluntary Assessments w 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: 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): t51ns•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 ' 1 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): 0 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrrown 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 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 1/day flow t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is "required for Centerville Ma. 02632 2/20/2009 every page. City/Town State Zip Code Date of'Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply. well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ❑ The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E). Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes" or"no" to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area (Interim Wellhead Protection Area— IWPA) or a mapped Zone II of a public water supply well If you have answered "yes" to any question in Section E the system is considered a significant threat, or answered "yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ;M 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrown 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? ® El information 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information Description: The septic system consists of a 1000 gallon septic tank,distribution box and a 1000 gallon leaching pit. Number of current residents: unknown Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection required] ❑ Yes [E No Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No 2007:54,000 Water meter readings, if available (last 2 years usage (gpd)): 2008:74,000 Detail 2007:148 gpd 2008:203 gpd Sump pump? ❑ Yes ® No Last date of occupancy: 2/20/2009 Date 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 L Commonwealth of Massachusetts v Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments ,M 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma: 02632 2/20/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts F Title 5 Official Inspection Form o Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria > Owner Owner's Name information is required for Centerville Ma: 02632 2/20/2009 every page. Citylfown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components;date installed (if known) and source of information: System installed in 1989 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 3' Depth below grade: feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain): Distance from private water supply well or suction line: 10+ feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints appear tight.No evidence of Ieakage.System vented through the house vents. Septic Tank(locate on site plan): Depth below grade: 30"feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 gallons Sludge depth: 8" t5ins•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form : Not for Voluntary Assessments GSM 8 Thoreau Drive - Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank (cont.) Distance from top of sludge to bottom of outlet tee or baffle 24" 5"Scum thickness 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 101, 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.): Pump septic tank every two years.lnlet and outlet tees are in place.No evidence of Ieakage.Tank appears to be structurally sound. 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•09108 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeCiliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 i_ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �M 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every 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 No 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.): Box is Ievel.Box has one outlet Iateral.No evidence of solids carryover.No evidence of leakage into or out of box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.): Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 d Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeCiliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1-1000 gallon ❑ 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.): Sandy dry soil.Leaching pit was full up into risers at time of inspection.No backup observed in d-box ,g.- because line to pit was piped into risers. 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-09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every 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•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 t Map Page 1 of 2 Town of Barnstable Geographic Information System Parcel Viewer F Custom Map Abutters Map Size Zoom Out: j I I I j I I jIn F � � z ' r Bi l r � .��'"�-�•:, fir" a g� 33 ':. :.� a �'Asp=r s y•4,� - ..... 4 AXpy .... 2D F.e. ..... ....... Set Scale 1" 20 I Aerial Photos I MAP DISCLAIMER f nn—inhf')nrlr_')!1nA T-un of P—nefohlc AAA all rinh4e mean„ http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertyID=191170&map... 2/26/2009 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ® Surface water ® Check cellar Z Shallow wells Estimated depth to high ground water: Bottom of LP 30'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: As-Built Card ❑ Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database_explain: You must describe how you established the high ground water elevation: USED:USGS Observation Well Data.USED:Technical Bulletin 92-000-01 plate#2 annual ranges of groundwater elevations. I Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 l Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 8 Thoreau Drive Property Address Patricia DeOliveria Owner Owner's Name information is required for Centerville Ma. 02632 2/20/2009 every page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist E Inspection Summary: A, B, C, D, or E checked E Inspection Summary D (System Failure Criteria Applicable to All Systems) completed E System Information—Estimated depth to high groundwater E Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•09/08 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 l a COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS + d DEPARTMENT OF ENVIRONMENTAL PROTECTION �t 0W p�M SVBv TITLE 5 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION Property Address: 8 Thoreau Drive Centerville,MA Owner's Name: Mr.Richard McGuire Owner's Address: 54 Baird Way MA Date of Inspection: 1/24/01 Name of Inspector: (please print) Mr.Carmen E.Shay FEB 0 5 2001 Company Name: Shay Environmental Services,Inc. TOWN OF I N 1 ABLE Mailing Address: 34 Thatchers Lane HMTH DE'T East Falmouth,MA 02536 Telephone Number: (508)-548-0796 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based 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: XX Passes Conditionally Passes A E Needs Further Evaluation by the Local Approving Authority E. Fails � AY T Inspector's Signature: Date: 1/24/01 The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection.If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments 5' effective depth available at time of inspection. Evidence of liquid level being 6" higher in Leach Pit due to being unoccupied. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page l Page 2 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McOuire Date of Inspection: 1/24/01 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. System Passes: XX I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system,upon completion of the replacement or repair,as approved by the Board of Health,will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined"please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: Page 3 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McOuire Date of Inspection: 1/24/01 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 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. _ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well".Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: Page 4 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McGuire Date of Inspection: 1/24/01 D. System Failure Criteria applicable to all systems: You must indicate"yes"or"no"to each of the following for all inspections: Yes No 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'/z day flow Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s).Number of times pumped Any portion of the SAS,cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. Any portion of a cesspool or privy is within a Zone 1 of a public 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 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.] (Yes/No)The system fails.I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd• You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) yes no the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply _ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. Page 5 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McOuire Date of Inspection: 1/24/01 Check if the following have been done.You must indicate"yes"or"no"as to each of the following: Yes No XX Pumping information was provided by the owner,occupant,or Board of Health XX Were any of the system components pumped out in the previous two weeks? XX _ Has the system received normal flows in the previous two week period? XX Have large volumes of water been introduced to the system recently or as part of this inspection? N/A Were as built plans of the system obtained and examined?(If they were not available note as N/A) XX _ Was the facility or dwelling inspected for signs of sewage back up? XX _ Was the site inspected for signs of break out? XX _ Were all system components,excluding the SAS, located on site XX _ 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? XX _ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes no XX _ Existing information.For example,a plan at the Board of Health. XX _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)] I_ Page 6 of 11 OFFICIAL INSPECTION FORM-NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 8 Thoreau Drive Centerville MA Owner: Mr.Richard McGuire Date of Inspection: 1/24/01 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 Number of current residents: 0 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system(yes or no): No [if yes separate inspection required] Laundry system inspected(yes or no): Seasonal use: (yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Sump pump(yes or no): No Last date of occupancy: Currently Unoccupied-Unknown COMMERCIAL/INDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203 Basis of design flow(seats/persons/sgft,etc.): gpd Grease trap present(yes or no):_ Industrial waste holding tank present(yes or no):_ Non-sanitary waste discharged to the Title 5 system(yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): Pumping Records GENERAL INFORMATION Source of information: None Available Was system pumped as part of the inspection(yes or no):— If yes,volume pumped: gallons--How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM XX 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): Approximate age of all components,date installed(if known)and source of information: 1989-per Owner&BOH Records Were sewage odors detected when arriving at the site(yes or no): No L I Page 7 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McQuire Date of Inspection: 1/24/01 BUILDING SEWER(locate on site plan) Depth below grade: 18" Materials of construction: cast iron XX 40 PVC_other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: XX (locate on site plan) Depth below grade: 10"to Riser Cover Material of construction: XX concrete_metal_fiberglass_polyethylene _other(explain) If tank is metal list age:_ Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 5' deep x 5'wide by 8' long (1,000 gallons) Sludge depth: 4.0' Distance from top of sludge to bottom of outlet tee or baffle: 2' Scum thickness: '/4 inch scum laver noted Distance from top of scum to top of outlet tee or baffle: 9" Distance from bottom of scum to bottom of outlet tee or baffle: 18" 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.): Structural integrity of tank was ok No evidence of cracks leaks or water infiltration/exfiltration. 4" PVC Tee present at inlet end. Outlet baffle present and in good condition. Liquid level equal with outlet invert. GREASE TRAP:_(locate on site plan) Depth below grade:_ Material of construction:_concrete_metal_fiberglass_polyethylene_other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations,inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): l Page 8 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McQuire Date of Inspection: 1/24/01 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/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches,etc.): DISTRIBUTION BOX: Not Present (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): PUMP CHAMBER: (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no): Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): L Page 9 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McGuire Date of Inspection: 1/24/01 SOIL ABSORPTION SYSTEM(SAS): XX (locate on site plan,excavation not required) If SAS not located explain why: Type XX 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.): No evidence of hydraulic failure,ponding damp soil or stressed vegetation. Excavated cover and inspected pit—5'effective depth available. No evidence of past hydraulic Failure noted. Lquid level has been 6" higher than at time of inspection. CESSPOOLS: (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth—top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): 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.): Page 10 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: 8 Thoreau Drive Centerville,MA Owner: Mr.Richard McGuire Date of Inspection: 1/24/01 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet.Locate where public water supply enters the building. THOREAU DRIVE Leach Pit Swing Ties: B A- Tank In—28' O O O B- Tank In—11' Exist House Septic Tank Septic Gal.) A-Tank Out—32' (1000 B-Tank Out—14' A A- -Leach Pit-40' B—Leach Pit—26' f Page 11 of 11 OFFICIAL INSPECTION FORM—NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION(continued) Property Address: S Thoreau Drive Centerville,MA Owner: Mr.Richard McQuire Date of Inspection: 1/24/01 SITE EXAM Slope Surface water -'/2 mile+/- Check cellar -Yes Shallow wells—None Estimated depth to ground water Over 20' feet Please indicate(check)all methods used to determine the high ground water elevation: Obtained from system design plans on record-If checked,date of design plan reviewed: XX 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) XX Accessed USGS database-explain: You must describe how you established the high ground water elevation: Checked with Quadrangle of USGS Map 30 8 E A?:VAIN meN i OIN �x3C. � - Ec�1��'QZA►h+���'t' ', 00 �uNP N %WiulAA%or4 Q t3 w glts R-I?VA; c o '. D - W I N O OWN S 29 x Sg A N D��SOtJ O.0 _ II« - �1ASLl1QtON WAl1' �'13Ah�ACED �GE-YILnKa R-�O�ACE}� - wRllCo�ER- : `(2" oRYwR1� 31 ►INDOW wItivvl WINDoY✓ i i (O/ ` 2' ZD g��RaOM � 0 I DO i { 21 LL ro 4 Zi Z I Q a A a I 16 w � w aix- N Z A-t t\C-K / A��'i C.r . I 3 � e 2C I n d 61 d� j ! � � ��� U- ZOOM v wALKO�AT 306$ r EC_KA K \CAL- �- l N � d TOWN OF BARNSTABLE LOCATIONS r t/ j fZf4l L) PrZ SEWAGE VILLAGE T'/A,SSESSOR'S MAP & LOT 191 INSTALLER'S NAME & PHONE NO.QP a UIT C-6 • �,�Ste'© SEPTIC TANK CAPACITY 11-rV-'j LEACHING FACILITY:(type) -----/-7, (size)44-t NO. OF BEDROOMS .3 PRIIVATE WELL OR PUBLIC WATER BUILDER OR OWNER / {�/�✓ i4/ DATE PERMIT ISSUED: DATE .COLIPLIANCE ISSUED:VARIANCE GRANTED: Yes - No w - i �� �� �j� ����i �' s No....94'Z::3 V1 '?Aec_e:L. V70 Fizic....1;_2 ........... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -------- .......OF.. . ...................................... Appliration for Disposal Works Tonstrurtion Prrutit Application is hereby made for a Permit to Construct (� or Repair an Individual Sewage Disposal System at: CF. A.Wa. ......... ...................................................... L��on-Address or Lot No. 41�-L.L 7,VZ—...................... ........ ....... )c H Address *............................................................. Installer Address Size Lot.... Z5-.Sq. feet U D Type of Building elling—No. of Bedrooms.....:3..................................Expansion Attic 4(P w Garbage Grinder ("C) '_l 04 Other—Type of Building ........................... No. of persons............................ Showers Cafeteria 44 Other fixtures - Design Flow.___._._..is.s—........'..'.'..'..'.'.'.'.-..gallons'per'person"per"d'?L y. Total daily flow.._.....5 3-C)......................gallons. 1( — C1 Septic Tank—Liquid*capacity.XQM.gallons Length..... Width..4".-.10... Diameter-----........ Depth.15!-S---- Disposal Trench—No..................... Width............__.._... Total Length..............._.... Total leaching area....................sq. ft. Seepage Pit No.........I.......... Diameter....... ....... Dept]-i below inlet...5�57...... Total leaching ar;a_Z.A ...sq. f t. Z Other Distribution box qt5; Dosmg-�Rnk (P5) Percolation Test Results Performed by.... j------C_ -------- Date.._.1. E7P 7............. Test Pit No. I..�Z....minutes per inch Depth of Test Pit... ....... Depth to ground water11'PrJeAACW"V0ZC-,) (14 Test Pit No. 2_4 ---..minutes per inch Depth of Test Pit....110.......... Depth to ground water....�!.5........... P4 . ........................................I ...................................................................;---- -------------="......*----------- 0 Description of Soil......I ......D . ...... .............. ..7ZL0.AvAq b0f3- . . . . . ................. -r..*...... ........ ... U�., AD........ ....... &- ---- J, )A ....?�..i ........... ............ ---------- -------------------------------------------------------------------...................................................................................................................................U Nature of Repairs or Alterations—Answer when applicable............................................................................................... ........................................................................................................................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of L'ITU 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by--the boa F4 of health. Signed......t�... ....................... ..........................A Date Application Approved By........... ......7.. Date Application Disapproved for the following reasons:................................................................................................................ ......................................................................................................................................................................................................... Date PermitNo..........0. ............... Issued....................................................... Date . ............. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH -ov-(.- 1................O s ► s. - Applirtaiion for Disposal Works Tnnstrnrtiun 11rrmit Application is hereby made for a Permit to Construct (�() or Repair ( ) an Individual Sewage Disposal System at: L oatlon-Address _ or��ffl of N_o. //,_. r� ............................ 1Z.!11.5 t 1 iU�.5"1.�.�:- _ -- -----------W l .............. /..... .........-/--......a .... _.._......__._f .............._..........._-........ ..._..-.............. L W / l/ — O ner . n- Address ............ ----- ..... ....... Installer Address , ` �� - U Type of Building Size Lot.... feet !-1 Dwelling—No. of Bedrooms____-:�_-.2_________________________________Expansion Attic 414), Garbage Grinder (la)(„D a Other—Type of Building ____________________________ No. of persons............................ Showers ( ) — Cafeteria ( ) d Other fixtures .._.. W Design Flow.......... __________________________gallons per person per day. Total daily flow---- ......................gallons. W Septic Tank—Liquid capacity_!=� gallons Length__�7r__-_ Width..!!.. idth-_ __�,O___ Diameter."""'�•__ Depth_ 8�� x Disposal Trench—No_____________________ Width.................... Total Length........... _____ Total leaching area-------------_.sq. ft. Seepage Pit No.........1.......... Diameter.......?........ Dep1t4below inlet__.?: ...._• Total leaching area___7'A�?. - ---sq. ft. Z Other Distribution box (\( Dosing nk Percolation Test Results Performed by..... �1t ! /�f G- W ... •••.•• Date �"'- .. �............. Test Pit No. 1...LZ:----minutes per inch Depth of Test Pit--- �'_ ....... Depth to ground water_!_wT�.........minutesPit .......... water a' .-••---••••. ••---------•......----••------ O Description of Soil.... 1 - O-2 LUt •4e »c�iSO i. <----10''S_ -�15tJ. G`� ��IEX ....... x - .. v = � - - - CD n.t Q. V G C._ W U Nature of Repairs or Alterations—Answer when applicable.............................................................•_.______.___.__._____.__.______.. --••---•-••---•-.--------•--__.._----•----------•-------------•----...-----•----•-.._.....--•--•---------•---------•---------------•----------------•-.................................................. Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLL 5 of the State Sanitary Code—The undersigned further agrees not to place the system in N operation until a Certificate of Compliance has been issue�boe boa• of health. Signed. .... _ ��` _-.•- Application Approved BY Date J' v �------------------------------------ .....�_-_.�`Ie--- Application Disapproved for the following reasons-------------•------•----------------•-----------------------------------......------•-----..Date -------------------••-•-•--...••------•---....--•---••----••------•---•----------••--•-------•-----•-....I--•--••-•••--------•--••-•----•••--•------•-•-------•-•---••••----•-••------•---•--•--••-•----- ? Date d ? r Permit No.............. . ----- ---...... . Issued....................................................... Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ........O F....... ! :c .................................. Orrtif iratr of TlantpliFanrr THIS IS 0 ER IFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by.......... ....•- .. .40— -c 4.......---------....--------- ...--------------- ----------.......-----..........--------- 4"97ler �}- �- .�-- has been installed in accordance with the provisions of TITLE of e State Sanitary Code as described in the application for Disposal Works Construction Permit No.___._____0(__'_ a__ dated................................................ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ,1 `lZ�� ...... inspector::" . DATE......... _...... ..-----••----------------•---•------..._......--- THE COMMONWEALTH OF MASSACHUSETTS oe BOARD OF HEALTH ►' „4..........OF...............� ,M--- �'�'= .Y.. *�_ No... ....._• FEE. ,, ?............. in rrr gal r �nno#.rt ion rrnti# Permission is hereby granted . -----------•............•-------------- ... to Construct or Repair ( ) an Individua ewage Disposal System atNo. - --------- ---------------._..--•-- --•••••••-•--••••••-----•••-•-••••--••-••-••••----••••-•••----•-•------•----•.. Street , as shown on the application for Disposal Works Construction Permit No. ______ Dated............................. -------------ad c ..................................... DATE. of Health , " ---... .. ................. FORM 1255 HOBBS & WARREN, INC.. PUBLISHERS it .... . . . . �..,.q...,.._,... .....:sue_..._y TvT-ZL L T g 7, o 97 �tzt��OvT�oPu �Ot� -f7¢A�iuA�C /s �Z� � 44 13 .... /IX7 j r i a SULLIVAN ,, ,�,:•"'�''`'' P/!mac � _ _� � •o � y f:, N0. 29733 �• -.� .i 3AsitiJ �''—� /02 p Z Lda^d.. ��� r •���o it ,9 �o �z 07 A41EPEc—/ AJVZT 5 i r-�� ZC ac T14E ZE G/ L-2L Z-XI A ?oW NoA..7<...... _ FIeE........ , THE COMMONWEALTH OF MASSACHUSETTS BOARD O OF.......... F-i EA leT'i-I �..- . ..........G - 1." Aptiration for Biopmal Wor�s,,Tatwtrurfivn ranfit Application is hereby made for ermit to C struct ) or Repair ( ) an Individual Sewage Disposal System ,... ............. ...... ----------......-- ------................................... Loca Address or Lot No. ------ -- w r Address a ------------- --•-•------------------------------•--.....------•........------.. •----....._.. Installer Address Type. of Buildir&/ Size Lot.�� ......... .......Sq. feet U Dwelling—No. of Bedrooms.•......... .................Expansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) Cafeteria .( ) PL4 Other fixtures W Design Flow................... ... . allons per person per day. Total daily flow........... gallons. tx Septic TanlC Liquid capacit _ Oallons Length................ Width................ Dia eter....__-_..-_.... Depth................ W Disposal Trench—N g q• x VVidt L To �leachin area s ft. Seepage Pit No................ Diameter_�� p role ........... o leachi .........sq. ft. z Other Distribution box ( ) Dosing tank ( ) L" C' �` •-' Percolation Test Results Performed by --- ------ Date aTest Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water_........................ (z, Test Pit No. 2................minutes per inch Depth of Test Pit____.__..__ a' --•-------------- -----•--••• ... ----- - O Description of Soil--------------------------- -- V -------------- -....... --------- •--------------------------- .._.............---------------------------- -------------------- •--------------- •-------------------- •------------------------•-------------- W ----------------••--••-----•----------•--•--•------•----------•-----------•--•--•----•-•-•-••--...-•----•-----------------------•---••--------•-•--------••---------•---•--••••---•-•-•---..........•--- VNature of Repairs or Alterations—Answer when applicable........................................................................................_...___.. ----------------------------••---•-••---•-----------------------•--•--•-••--•-------...---...--------------•------------------------------------------•------------------------------------••-•---_..._. Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of h h. Signe --- ------ - --- '•-- • J----........................... Date Application Approved BY --........... - / . � � Application Disapproved for the following reasons: ------------------------------ --------••--...ate-----------'-- --.......-•-•---•--•----•--•----•-•-------------------------------------'---•....---.-----•------..._._..-•------------••-•-----•-•-------------------------•--------------------------.....------..... Date PermitNo......................................................... Issued........................................................ Date ...............................................� THE COMMONWEALTH OF MASSACHUSETTS BOARD O HEALTH ---------.OF.......... ... .. - --i----------......-_._.. ...._ . AvOiration for Viiivogal Worho nnitrnr#i.on runfit Application is hereby made for a Vermit to C nstruct ) or Repair ( ) an Individual Sewage Disposal system : �.....--••' L oca i •---- .•---- ...... . ------- ------------- ......----.. Address _ . L ' No. r .. ....... .... .................. .................................................... +� .. .. - ................................ .......... W W er Address f -•- •------•--... Installer, Address Type of'Buildi Size Lot.��„y4y'��' w__Sq. feet Dwelling-!-'-No. of Bedroom' s............ ................Expansion Attie ( ) U'arbage Grinder ( ) a Other-Type-of Building ............................. No. of persons..:.......................-- Showers ( ) — Cafeteria ( ) Other fixtures - _..... ---•-----•-----------•-------- --•-•- W Design Flow,.............. _ allons per person per day. Total daily flow........... :_.. _ ............gallons. WSeptic TanLiquid capac>t�_.__.-" allons Length................ Width_____.._...____ Di eter.-•----._--`--•- Depth................ x Disposal Trench N . -•-•--•--••-------.. Widt -- 1 bleaching area....................sq. ft. Seepage Pit No:.__. ,}� Diameter. e >nle ---_-_ •-----_--- 0 1 chi�r� arY...._:-_--.-s ft. f --- --- 6 P ! q. Z Other Distribution box ( ) Dosing tank Percolation Test Results Performed by --••---••---.-- ----- Date F4 Test Pit No. 1................minutes per inch Depth of Test Pit.................... Depth to ground water........................ 4q Test Pit No. 2.....:..........minutes per inch ,Depth of'Test Pit.......... _..___ Depth to ground water............._..... a ---- �j O Description of Soil ' l " ------------•------•--------------- ----- ......................................_- - .. ..................................., ----------------------------------- ------•-•••-•-....-----_-- V Nature of Repairs or Alterations—Answer when applicable....................................................................:........................... --•---•-•-----------------------•-•-----••-----•---------•••-•-•-•---•------•------•-•-•-•--•-•--•----•------------................ Agreement The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of Article XI of the State Sanitary Code— The undersigned further agrees not to place the system in operation until a.Certificate of Compliance has been iss ed by the board of high. Y Signe .... ----- ...... - ---- _._.. ..... }�ate Application Approved BY•----.ttt.....--- -- ...... [ = f r ate Application Disapproved for the following reasons------------------------------------ -• -------------------------------------._..._--•-•-------•----_.... -------------------------------------•------------------------...--------.:....-----...------.....•-----.--•-•----•---------••-------------------.....------------------•---•-------_._--------••-•_.... Date Permit No................................ ._.. Issued ...:----•-•-• ........................................................ Date THE COMMONWEALTH OF MASSACHUSETTS BOARD HEALTH OF..... .. .;: ..................... .. .'. ��'WY`ttfiratP of Tou4itiM1trP THIS 0 RTIFY, t the Individual-Sewage Disposal System constructed (� ) or Repaired ( ) by........- . ............. . -•-•-•-------------------------------------------------------- •-•---------__--- - i t ii ns a r at__`*''___ 1...,," _______________ j_ .____..__...._._......._..__....._....._.._.._.___-__..........._.___.___..._ has been installed in accordance with the provisions of Article X of The tate Sanitary Coe a descri ed in the application for Disposal Works Construction Permit No....''"...... _. --- --- -------- dated------- '.-:' .�!�---. ---7 ....... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE....................................•-------•---•--....-••---•••-----...---•••_. Inspector.................................................................................... THE COMMONWEALTH OF MASSACHUSETTS BOARD OF .HEALTH t .......OF....... 4 :2 . .. . ...r..................................... No.------.A F FEE.. .. i �rrr�n n Tn #rurtton rrntit Permissio s ereby granted-... ......................................... to Construct r Repair wage Dispos S tem at No.` + �La� �Inkvi + ' t _! 0 ....................... SUpet as shown on the application for Disposal Works Construction P t No.6.nw.. ated.......................................... ... Board of Health DATE.................:.............................................................. FORM 1255, HOBBS & WARREN, INC., PUBLISHERS. , o 'r , M ' P its, - • P , , c - . . :. .D � 71. Y y r j1 ry CENTERVILLE � p�O . T,9 cF 0 N � �a Locus Q; msp PortsR '0.p i1 I O_ t til LO Y W BAS O SS `t Uj N O ® ti o, r a G-' - ven LOCUS MAP CATCH BASIN �=' `�, ° , ,_ �t ,CATCH BASIN \0 ELEV.=52.7 , w ---- _ �N 53 � ,CATCH LOCUS INFORMATION 0 PLAN REF: 272/58 10 i' w G 93, �c i —\�� \ t`+rB;i TITLE REF: 23527/291 PARCEL ID: MAP 191 PAR. 170 S \\ ` �� �, :./ FLOOD ZONE: "C" DMOH CBA 3 i' 7 12"OAK ��\ cJ \\ xr t t COMMUNITY PANEL: 250001-0015—C OATED:08/19/85 #8 = ���� � \ � \� �\� ``�\`� SEPTIC SYSTEM 3—BEDROOM -- ',-',- ,—�— --� � ` �� � `, `, `s �,� REPAIR PLAN �s� � DWELLING _ �:%' �o"OAK ` \\o \ \ \ S1 ,2 GENERAL NOTES: — \ `c^ LOCATED AT: v _:TOF=55.0 (GIS±l__ Q \ `tt I. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL - > `, 6 �\ {1 \ BOARD OF HEALTH AND THE DESIGN ENGINEER. 8 TH 0 R E A U DRIVE `` t 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REQUIREMENTS \ �'� \ _ `� �s a,\ �`It OF THE STATE ENVIRONMENTAL CODE, TITLE V, AND ANY APPLICABLE C E N-TE R VI L L E M A. 11 LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: LA \ , __— `, \• \ a \\� \ \ - 310 CMR 15.405 (1) (B): PREPARED FOR � � � � � �cD��cD ' �� �t✓� \ Cp 1) A 1.55 FT. VARIANCE FROM 310CMR15.221(7) TO ALLOW LEACHING �P �p�-�' ��� ` J TO BE 4.55 FT (MAX) BELOW GRADE VS REQ'D 3 FT. B 0 U S E F I E L D SANITARY J �E�' ��• \ ` N' 0 (H20/VENT PROVIDED) PRIOR SERVICES NP \ DR. M PIPE r i 3' TOEI SPECTIONSAGEI SPOSAL AND APP OVALM BY THE SHALLN BOARD OFCHEALTH AND THE 2012 1 \ S7 DESIGN ENGINEER. MAY 1 S, m \ ` 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING ENGINEER BEFOREOM THOSE WN HEREON CONSTRUCTION ONTINUESREPORTED TO THE DESIGN OF 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF G THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF DAB N// 00 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. N 7. WATER SUPPLY PROVIDED BY TOWN WATER SERVICE. v y No. 1140 8.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED UPON BETWEEN OWNER AND CONTRACTOR. G/ EQ r 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY { / i. THE LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO BEGINNING `£4NITAR�a� C J g y LOT 4 150 pp CONSTRUCTION. AREA=15,625f S.F. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND FILLED PER TITLE V. 1 „ 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION N8,of 36 E LOT 5 1 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY + AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY 13. NO PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING MEYER & SONS, INC. 14. PIPE TO BE 4" SCH 40 ® 1/8"/FT (UNLESS SPEC. OTHERWISE) I 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW 1 FOR THE USE OF A GARBAGE GRINDER P.O. BOX 981 16. NO WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING 17. REMOVE UNSUITABLE SOILS 5 FT AROUND LEACHING TO EL. 46.55 EAST SANDWICH, M A. 02537 OR TOP OF "C" LAYER AND REPLACE W/ CLEAN MED. SAND PER TITLE 5 SPECIFICATIONS. (5 0 8)3 6 2—2 9 2 2 17. INSTALLER TO PLACE 40 mi POLY LINER AS SHOWN FROM EL. 49.95 SCALE: 1 = 20 TO EL. 46.55 TO PREVENT BREAKOUT. SHEET 1 OF 2 J 1416 NOTE: TO PREVENT BREAKOUT, THE PROPOSED NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS FINISH GRADE SHALL NOT BE < EL:49.95 irA. FOR'A DISTANCE OF 15' AROUND THE PERIMETER OF THE S.A.S. - tf SEPTIC TANK PROPOSED D-BOX PROPOSED S.A.S. t T.O.F. EL.=55.00 INSTALL RISERS & COVERS OVER INLET & INSTALL RISER & COVER INSTALL A 4" DIAMETER INSPECTION PORT OVER INSTALLED OUTLET AND SET TO 6" OF FINISH GRADE SET TO 6" OF GRADE ONE CHAMBER (MIN.) AND SET TO 3" OF F.G. LENGTH ' F.G. EL.=54.00t F.G. EL.=53.80f F.G. EL:54.Of F.G. EL: 54.0-54.5(MAX.) ���� OF MASS, 9.45" DARRN :9" MIN COVER VENT= 1 't R ' _ = TALL TWO INSP CTION P N:O L 2 36" MAX COVE L 10' L 15'(MAX) INS E PORTS (MIN.) 12.37" 0 S=1% (MIN.) EL. 51.16 0 S=1% (MIN.) O S=1% (MIN.) 4"SCH40 PVC 4"SCH40 PVC 4"SCH40 PVC ,D. 6 10.38" To SANI TAR�a� INV.= 50.16 �•uoulD 14. INVERT LEVEL �INV.=49.91 PROPOSED INV.= 49.49 COUPLER DETAIL I GAS BAFFLE 4 ROWS OF 4 UNITS 05'/UNIT + 3 COUPLERS 01.16'/UNIT = 23.48'/ROW D-80X INV.=49.81 DB-5(H-20) INV.=49.64 SOIL ABSORPTION SYSTEM (PROFILE) EXISTING 1,000 GALLON SEPTIC TANK EXISTING OUTLET RESTORE VEGETATIVE COVER BACKFILL WITH CLEAN PERC SAND L� 60• NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TO TOP OF CHAMBERS PIPE INVERTS PRIOR TO CONSTRUCTION 2) D-BOX SHALL BE SET LEVEL AND TRUE TO BREAKOUT=TOP ELEV.= 49.95 GRADE ON A MECHANICALL COMPACTED SIX INV. ELEV.= 49.49 INCH CRUSHED STONE BASE, AS SPECIFIED IN 310 CMR 15.221(2) BOTTOM ELEV.= 48.62 EXISTING SUITABLE 3) REPLACE EXISTING 1,000 GALLON SEPTIC TANK 2.88' MATERIAL WITH 1500 GALLON SEPTIC TANK IF FAILED, 5' MIN. ABOVE BOTTOM OF T.P. EXCAVATION OR G.W. EFFECTIVE WIDTH -'4 x 2.88' = 11.52 DAMAGED, NOT H2O LOADING, OR UNDERSIZED. (6.07' PROVIDED) USE. 4 ROWS OFJ4-ADS ARC 36HC 4) INSTALL INLET & OUTLET TEES W/ - GAS BAFFLE AS REQUIRED BOTTOM OF TESTHOLE EL.=42.55 _ (H20) UNITS - NO STONE W/ 3 COUPLERS IN EACH ROW , • SEPTIC SYSTEM PROFILE TYPICAL SECTION 1s" I N.T.S. n.rs SOIL LOG P#: 13498 DESIGN CRITERIA DATE: DECEMBER 28, 2011 SECTION fo3s` NUMBER OF BEDROOMS: 3 BR DESIGN SOIL EVALUATOR: DARREN M. MEYER, R.S., CSE. #1614 INVENT END CAP } WITNESS: DONALD DESMARAIS, BARNSTABLE BOH SOIL TEXTURAL CLASS: CLASS I � TP-1 Depth Elev. TP-2 Depth ADS - ARC 36HC CHAMBER H2O LOAD) I DESIGN PERCOLATION RATE: <2 MIN/IN 81' I 54.30 0". 54.70 0" I DAILY FLOW: 110 G.P.D/BR. DESIGN FLOW: 330 G.P.D. Flu Flu MODEL ARC 36HC GARBAGE GRINDER: NO (NOT DESIGNED FOR GARBAGE GRINDER) 49.22 A LOAMY61" 49.62 61" LENGTH 63" NOTE: UNIT CONFIGURATION AND AVAILABILITY SUBJECT SEPTIC TANK: 330 gpd x 200% = 660 gpd USE EXIST. 1,000 GALLON SEPTIC TANK s/D A LOAMY 10YYR 3o EFFECTIVE LENGTH 60" TO CHANGE WITHOUT NOTICE. PRODUCT DETAIL MAY 48.72 67;' 49.12 67" DIFFER SLIGHTLY FROM ACTUAL PRODUCT APPEARANCE LEACHING AREA REQUIRED: (330)/0.74 = 445.94 S.F. B B . SIDE WALL HEIGHT 10.38" LOAMY SAND LOAMY SAND OVERALL HEIGHT 16" I DISTRIBUTION BOX: 5 OUTLETS (MINIMUM)(H20 LOADING) 1OYR 4/6 10YR 4/6 4640 TRUEMAN BLl/D 46.55 93" 46.95 g3" OVERALL WIDTH 34.5' I PRIMARY S.A.S. C C 10.7 CF IffAme HILLIARD, OHIO 43026 i MEDIUM SAND i MEDIUM SAND CAPACITY USE 4 ROWS OF 4 - ADS ARCHC 3616 H2O UNITS-NO STONE 2.5Y 6/4 t 2.5Y 6/4 (80.0 GAL) ADVANCED DRAINAGE SYSTEMS, INC. AND EXTENDED 1.16' W/ COUPLERS IN BETWEEN EACH UNIT SIEVE 0 PROPOSED SEPTIC SYSTEM/SITE PLAN I. BOTTOM AREA: (GENERAL USE APPROVAL FOR 4.80 SF/LF OF CHAMBER) EL. 45.0 (CHAMBERS: 4/ROW)16 UNITS x 5.0 LF x 4.80 SF/LF = 384.00 SF 42.55 1411" 42.95 141" RIVE NT RVILLE MA ' (COUPLER: 3/ROW) 12 UNITS x 1.16 LF x 4.80 SF/LF = 66.82 SF j 8 THOREAU D C E E , } TOTAL AREA = 450.82 SF PERC RATE <2 MIN/IN. ("C" HORIZON) PER SIEVE SAMPLE Prepared for: Stapleton !( DESIGN FLOW PROVIDED: 0.74GPD/SF(450.82SF) = 333.60 GPD > 330 GPD req'd NO GROUNDWATER OBSERVED SCALE DRAWN -- Engineering by: Surveying by: MEYER&SONS,INC. ifooDougamsurver NTS D.M.M. • I, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 POBOX981. (508) 375-0735 DATE: to conduct soil'evaluations and that the above analysis has been performed by me consistent with the EAST SANDWICH,MA 02537 CHECKED SHEET NO. requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Eval. Exam in October, 1999. 05/15/12 D.M.M. 2 OF 2 50"62-2922 y