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HomeMy WebLinkAbout0055 BUNNY RUN - Health 55 Bunny Run Barnstable / A = 234 = 024 0 L - �. �'��-fir .•rr . i ! Town of Barnstable Barnstable Regulatory Services Department MASS Public Health Division 200 Main Street, Hyannis MA 02601 , 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 3227 February 29, 2016 John P Frazee 55 Bunny Run Centerville, MA 02632 .� , The septic system located 55 Bunny Run, e;4Yle, MA was last inspected on 1/04/2016 by James D. Sears, a certified septic inspector for the State of Massachusetts. The Health Division has determined that the system"Fails". • Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS. You are ordered to repair or replace the septic system within one (1))year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH OARD OF HEALTH T omas ean, R.S. CHO Agent of the Board of Health Q:/Septic/Letters Septic Inspection Failures or Future Eval/55 Bunny Run Cent Jan 2016 • Barnstable Tows of Barnstable, Regulatory Services Department MASS AB Public Health Division Q D• asv a 200 Main Street, Hyannis MA'02601 200� . Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A..McKean,CHO CERTIFIED MAIL# 7015 1520 0001 2273 2589 January 19, 201E - John P Frazee 55 Bunny Run w Centerville, MA 02632 e 55 Bunn Run i e .MA as last inspected on The septic stem located R w Y � � p P Y • 1/04/2016 by James D.Sears, a certified.septic inspector for the.State of Massachusetts. The Health Division has determined that the system"Fails". • Static liquid level in the distribution box above outlet invert_ due to an- overloaded or clogged SAS. You are ordered to repair or replace the septic'system within one (1))year from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will.result in future- enforcement action. PER ORDER OF THE'BOARD OF HEALTH as McKean, R.2SCH—O ` Agent of the Board of Health Q:/Septic/Letters Septic Inspection Failures or Future Eval/55 Bunny Run Cent Jan 201E , Town of Barnstable BAR?M0r E NKIAn ,.m Regulatory. Services Department 'rFa MJ►�" - Public Health Division 200 Main Street,Hyannis MA 02601 Office: 508-862-4644 Richard Scab,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6,-2007 Rev. 7/6/15 DEADLINES TO REPAIR FAILED SYSTEMS (Town Code §360-44-and Title V: 310 CMR 15.000) An"x"marked in the ❑ is the failure criteria and associated repair deadline, 60 DAY DEADLINE CRITERIA t ❑Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 times during the last year not due to clogged or obstructed pipe ❑ Backup of sewage into the house due to an overloaded or clogged SAS or cesspool ONE (1)YEAR DEADLINE CRITERIA Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or,cesspool ❑Any portion of the SAS, cesspool, or privy below high groundwater elevation . ❑Any portion of the cesspool within a Zone 1 to a public well - ❑Any.portion of a cesspool within 50 feet of a private water supply well with no acceptable water quality analysis. (This system passes if the water analysis indicates the well is free from pollution). TWO (2)YEAR DEADLINE CRITERIA - ❑ Single Cesspool ❑ Any"conditionally.passed systems" (broken cover,relocation of a pipe,relocation . of a driveway due to H-10 components; etc) ❑.Leaching pit or cesspool with high liquid level; -512"below inlet(per Town Code §360-9.1). OTHER ❑ j. Repair deadline: WSEPTIMDEADLINES TO REPAIR FAILED SYSTEMS.doc 1 Parcel Detail Page 1 of 5 ff . ' f. I *` a tt��ti sr�t�L y r ' m ' Logged In As: Pa C'C2I Detail Wednesday,January 13 2016 Parcel Lookup Parcel Info Parcel ID 234-024 "� DevelopeerLot LOT 30 Location,555 BUNNY RUN Pri Frontage 120 r......�..�.��...,.._..�H,.,...,a, .,.�.»,�,p,.,.�. I Sec Road Sec 1 Frontage Village(BA STABLE Fire District BARNSTABLE � Town sewer exists at this address.No Road Index 0197 � I Asbuilt Septic Scan: Interactive 234024_1 Map fr , 234024_2 Owner Info Owner F-RAFEE, J OOHN Co-OwnerF Streetl f55 BUNNY RUN I Street2 City CENTERVILLEI State MA zip '02632 Country Land Info Acres ,0.41 � Use Single Fam MDL-01 I zoning FRF-1 � ��� Nghbd 10105� Topography .L�eve! Road rPaved Utilities Public Water,Gas,Septic wI Location Construction Info Building 1 of 1 Year F,964 "'�` "I Roof ,Gable/Hip J Ext 'Wood Shingle Built� Struct WaIG Living f 11076 Roof A�phjF GIs/Cmp. AC JNon� Area Cover Type A � Int ..�� �. Bed t1a ar ,t Style SRanch _._ Wall Drywall Rooms tG Bedrooms - o Bps Int Bath aCP,�2 6 ; Model EesidenfL I Floor!Hardwood _ I Rooms•Full-0 Half „ ; Heat Total �`�7aBMT� Grade jZverage Type Hot Water I Rooms 4 Rooms stories 1 Story —`"I Heat Gas I Found Poured Conc. ( ' Fuel ation Gross.v`- -,m,-.�,�,...... Area 12576 Permit History http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=16731 1/13/2016 ,dn--'05 2016 23:42 Jim The Inspector Man 5085349919 page 1 Commonwealth of Massachusetts = Title 5 Official Inspection Form s Subsurface Sewage Disposal System Form -Not for Voluntary Assessments= , h 55 Bunny Run 1 y Property Address John Frazee :r Owner Owner's Name information is �I c � required for every 9167 i 0'"j""1�0 MA 02632 1-4-16 page. City own State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When A. General Information on the filling comput uter, r �# //3S� ``►u�u�I�Wp� use only the tab ��•``�zo`` a CF M'f/�,Iz, key to move your 1, Inspector: _� •. 9� •yaS use return not ,lames D.Sears `��: JAMES use the return m key. Name of Inspector * cn Capewide Enterprises, LLC ; �•, o o �*; rp Company Name d cr:W N 153 Commercial Street ��'''/.�F 5 INSP�G���`�` Company Address Mashpee MA 02649 Cltyrrown State Zip Code 508-477-8877 S 1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems: I am a DEP approved system inspector pursuant to Section 16.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 1-4-16 ;Pecatogrs Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or-DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner.shall submit the report to the appropriate regional office of the DEP. The original should be sent to'the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �� V t51ne•3/13 Title 5 Official Inspection Form.subsurface Sewage Disposal Syst •Page 1 or 17 Jah -U5 2016 23:42 Jim The Inspector Man 5085349919 page 2 Commonwealth of Massachusetts Title 5 Official Inspection Form a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information is Centerville required for every MA 02632 1-4-16 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: Failed -Leaching. The system is a 1500 Gal-Tank D Box and two 500 Gal. Chambers. Note: Outlet tee has a filter. 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. r Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain" The septic tank is metal and over 20 years old'or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. A metal septic tank will pass,inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank Is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3r13 Title 5 Official Inspection Form.Subsurface Sewage Disposal System-Page 2 of 17 Jan =`05 2016 23:42 Jim The Inspector Man 5085349919 page 3 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information is required for every Centerville MA 02632 14-16 page. Citylrown State Zip Code Date of In B. Certification (cont.) j ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired, B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or breakout or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required.pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health)- ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: El 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 151ns•3113 ritle s ofrlciel Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Jan :=05 2016 23:42 Jim The Inspector Man 5085349919 page 4 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Y o untary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information is Centerville required for every MA 02632 1-4-16 page. Ctty/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fall unless the Board of Health (and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes".or"No"to each of the following for all inspections: Yes No ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ® ❑ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in amspWis less than 6" below invert or available volume is less than '/day flow.4 Fi,lP/li.vr . ISina•3113 Tifie 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Jan =05 2016 23:42 Jim The Inspector Man 5085349919 page 5 Commonwealth of Massachusetts NMI Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owners Name informationis required for every very Centerville MA 02632 1-4-16 page. Cityrrown State ZIP Code Date oflnspection 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 collform 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.j ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® The system falls.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 11 of a public water supply well If you have answered "yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section 0 above the large system has failed. The owner Ior 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. thins•3113 Title 6 Ofriclal Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Jan _-05 2016 23:42 Jim The Inspector Man 5085349919 page 6 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name informatlon Is Centerville required for every MA 02632 1-4-16 page. CltyrTown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period?. ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health, ❑ ® Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms(actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 wi 16ins•3113 - Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Jan -705 2016 23:43 Jim The Inspector Man 5085349919 page 7 Commonwealth of Massachusetts Title 5 Official Inspection Fora, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information a Centerville MA 02632 1-4716 required for every page. City/Tcwn State Zip Code Date of Inspection D. System Information Description: The system is a 1500 Gal. Tank D Box and two 500 Gal chambers Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection El Yes ® No information in this report.)" Laundry system inspected? ❑ Yes ® No Seasonaluse? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): 2014-59,000Gais Detail: 2015-55,000Gal's Sump pump? ❑ Yes ® No Last date of occupancy: Present Date CommerciaUlndustrial 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.): C : 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: l5ins•3/13 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Jan--05 2016 23:43 Jim The Inspector Man 5085340919 page 8 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information is Centerville required for every MA 02632 141-16 page. Cityrrcwn 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: NA Was system pumped as part of the inspection? Q Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, sail absorption system ❑ Single cesspool ❑ Overflow cesspool . ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins+3/13 Title 5 Official Inspecion Form:Subsurface Sewage Disposal System page B Of 17 Jan.•05 2016 23:44 Jim The Inspector Man 5085349919 page 9 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owners Name information is required for every Centerville MA 02632 1-4-16 . page. City/Town State Zip code Date of Inspection D. System Information (cost.) Approximate age of all components, date installed (if known)and source of information: 1998 Permit # 98-796. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 18" Depth below grade: feet Material of construction: ❑cast iron ® 40 PVC ❑ other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4"PVC SCH 40. Septic Tank(locate on site plan): Depth below grade: 8"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: 1500 Gal. Precast H-10 Sludge depth: 31 15ins•3/13 Tille 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Jan••05 2016 23:44 Jim The Inspector Man 5085349919 page 10 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 55 Bunny Run Property Address John Frazee Owner Owner's Name Information is required for every Centerville MA 02632. 1-4-16 page. City/Town State Zip Code Date of In D. System Information (cost.) Septic Tank(cunt.) Distance from top of sludge to bottom of outlet tee or baffle 30" Scum thickness 1" 8 Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 20" How were dimensions determined? Asbuilt-Tape Sludge Judge Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at workinng level. Tank and covers at 8" below grade Win and outlet tees. Out let tee not set level, outlet line has to much pitch. No sign of leakage. Note: Inlet tee and line should be water blasted. Note: Outlet tee has a filter. 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Jan 05 2016 23:44 Jim The Inspector Man 5085349919 page 11 Commonwealth of Massachusetts a Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name information is required for every Centerville MA 02632 1A-16 . page. City/Town State Zip Code Date of Inspection D. System Information (cost.) 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, y ❑ 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 t5ino•3113 Title 5 official Inspection Form:Subsurface Sewage Disposal System•page 11 of 17 f Jan--05 2016 23:45 Jim The Inspector Man 5085349919 page 12 Commonwealth of Massachusetts Title 5 Official Inspection 'Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owners Name information is Centerville required for every MA 02632 1-4-16 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 1 1/2 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 16"x16"-16" below grade w/one line out. Wall's are gone, outlet line in 1 112"water. Need to replace D 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.): * If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: 15ins•3113 Title 5 Official Inspection Form:Subsurface Sawago Disposal Systen•Page 12 of 17 Jan•-05 2016 23:45 Jim The Inspector Man 5085349919 page 13 Commonwealth of Massachusetts Title 5 Official Inspect;ion Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ` 55 Bunny Run Property Address John Frazee Owner Owner's Name information is required for every Centerville MA 02632 14-16 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: ® leaching chambers number: 2 ❑ 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.): Leaching is two 500 Gal. Chambers. Chamber's are 23" below grade. Leaching is full up into inlet line. Need to replace leaching 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Jan• 05 2016 23:45 Jim The Inspector Man 5085349919 page 14 a Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 55 Bunny Run Property Address — Joh n.Frazee Owner Owner's Name information is required for every Centerville MA 02632 1-4-16 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.): 15ine•3113 Title 5 Official Inspection Form Subsurface Sewage Disposal System-Page 14 of 17 Jam,05 2016 23;46 Jim The Inspector Man 5085349919 page 15 Commonwealth of Massachusetts Title 5. Official Inspection Form Subsurface Sewage Disposal System Forth -Not for Voluntary Assessments 55 Bunny Run Property Address John Frazee Owner Owner's Name r Isinformation equired for every Centerville MA 02632 1-4-16• page. Citylrown State Zip Code Date of Inspection D. System Information (cont_) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below- . ® hand-sketch in the area below ❑ drawing attached separately i 9 6 134 °r 3 B- 3� 8 r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage O}sposal System-Page 15 of 17 JanTt 05 2016 .23:46 Jim The Inspector Man 5085349919 page 16 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary P Y Assessments 55 Bunny Run Property Address John Frazee Owner Owners Name information is required for every Centerville MA 02632 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope El Surface water ❑ Check cellar ❑ Shallow wells A141 30'+ Estimated depth to high ground water: feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: 12-18-98 Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain: . You must describe how you established the high ground water elevation: G.W. off past report 30'+. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins 3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Jana 05 2016 23:47 Jim The Inspector Man 5085349919 page 17 Commonwealth of Massachusetts Title Official Inspection Fora, Subsurface Sewage Disposal System Form -Not for Voluntary Assessments f 55 Bunny Run Property Address John Frazee Owner Owner's Name information is Centerville required for every MA 02632 1-4-16 page. CrtyrTown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information— Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached jn separate file t5ins-3/13 Title 5 Official Inspect on Form:Subsurface Sewage Disposal System•Page 17 of 17 TOWN OF BARNSTABLE LOCATION J6V iJ "4 0,0&1 SEWAGE# VILLAGE jq,4,JJS�4 L�ASSESSOR'S MAP&PARCEL ;?.. INSTALLER'S NAME&PHONE NO. CR P�i0t Ar-- 15iJT��` s OF tS� L- V7� 7� SEPTIC TANK CAPACITY I , 5-00 C.+LLZIj LEACHING FACILITY:(type))() ( c t�A BLS(size) 12,13 3'Y, NO.OF BEDROOMS +� OWNER -TO 14 {- Z PERMIT DATE: COMPLIANCE DATE: 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) MIA Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) �fMIA Feet FURNISHED BY0-r-;u3LDiC &L7nD �iQ_ OU f 7 A zq35.5 ° eLKIL s A-3; 31.11 Q�S 31.9 ° C-1 41' No. b `'`� Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: es PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Rppl Lation for MispOsal 6pstrm Construction Permit Application for a Permit to Construct( ) Repair(X Upgrade( ) Abandon( ) ❑Complete System ndividual Components Location Address or Lot No. D O(4 MI-( D-C� Owner's Name,Address,and Tel.No. 3oN� �RAZ�� bA NAi TABLA ' Assessor's Map/Parcel R 3q � ), V �� �D j LLI= Installer's Name,Address,and Tel.No. Designer's Name,Address,and Tel.No._50$—�.q —z�42 QVA7-'IXt0 SAN1 9t4TtC�klSctt�'s�S Gacr.� � cAt� 3i" ��EPEs 3qt, MTIC i) MAR�I® S Type of Building:'Dtu,/� Dwelling No.of Bedrooms Lot Size 1 © sq.ft. Garbage Grinder( ) Other Type of Building P,66'llf J;�Jrj A-k No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) 330 gpd Design flow provided _3" gpd Plan Date :P 19—aQ 1 Number of sheets Revision Date Title 55 t yiloy Size of Septic Tank 1$00 Type of S.A.S. Description of Soil qj Eq) /<�O R 4 LES, �W 5.3 Nature of Repairs or Alterations(Answer when applicable) (�S�' GXtSTt (0 C ,, /5 C>0 5 tE17T((�,740 K iu tom) H- ID d)`Ae)C iU (g) 5-0© C-.4L"Aj v- I® G� 48C—XS Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board of Health. Siguad Date _a,3—odd`, Application Approved by Daie Application Disapproved by Date for the following reasons Permit No. (�` Date Issued Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: I PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS es Zipprication for MisposaYffipstem (Construction Permit ' Application for a Permit to Construct( ). Repair(X Upgrade( ) Abandon( ) ❑Complete System Vndiidual Components Location Address or Lot No.1 55 DUJs.1N� Rv� Owner's Name,Address,and Tel.No. Assessor'sMap/Parcel ZORIJ �RAZr� BAW. - Tf4f3LIG7 a3 r1 - v Installer's Name,Address,and Tel.No.S68"'E7Z-$�S 7'1 Designer's Name,Address,and Tel.No.508_XqA_Z$49 G4Pewtos ato-&w4s6r C vat VC rJC r-J-�4�-le�+c/s��Cs �;_ . Type of Building:,-_✓kf, 8-ZZ Dwelling No.of Bedrooms m 1.14Lot Size a O± sq.ft. Garbage Grinder( ) Other Type of Building Ran Z ohs A. Ng.of Persons Showers( Cafeteria( ) Other Fixtures Design Flow(min.required) _ gpd Design flow provided 2" gpd Plan Date 7 yi Al[0 Number of sheets 7.. Revision Date Title !t Size of Septic Tank- �� Type of S.A.S.6R ) 5, 64unw .4� S Description of Soil 0%E�7) J;5 („J =T�1. L�../ES5.&I Nature of Repairs or Alterations(Answer when applicable) 40 C--- G)CI("r/&-i C-C 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. Si d Date Z - 3^40 (n Application Approved by Date X101 /1 Application Disapproved by Date for the following reasons ._ Permit No. 1 J) Ll Date Issued ---------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site Sewage Disposal system Constructed( ) Repaired(,X Upgraded( ) Abandoned( )by_CA9eArt & Lmelesg&es. �(.0 at �� � - �7 .� dpt�^7 �� has-been constructed in accordance with the provisions of Title 5 and the for Disposal System Construction Permit No. h - l/Sdated Installer CA06 )0d*:_ 45)0?EtPQI9M CAL-C.. Designer ��.2.4'Q 1 AJ O S l T T/Akj 1Cj;;3 #bedrooms „J Approved design flow 330 gpd The issuance of his pe it shall not be construed as a guarantee that.the system will o as designe . Date 1) t,/// -- Inspector ----------------------------------------------------------------------------------------------------------------------------------------- No. Fee 6(jo THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem Construction Permit Permission is hereby granted to Construct( ) Repair(y) Upgrade( ) Abandon( ) System located at t 1)A/A J Q U x/ 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:Cons ction jnust be completed within three years of the date of this permit. Date 2- 2- l/ �, Approved by G'� ; r i� c Town of Barnstable oFt"e,�,c Regulatory Services �• Richard V. Scali,Interim Director ' BABNSTABLE, 9 MASS. $ Public Health Division Gb i63q, `� ArFota Thomas McKean,Director 200 Main Street,Hyannis,MA 02601 ,t Office: 508-862=4644 Fax: 508-790-6304 ' Installer& Designer Certification Form r Date: I-;Lq-1 1(0 Sewage Permit# �R016 -O Lt 5 Assessor's Map\Parcel 9L3: OR i4 Designer: Trri ��ri rl0, R Installer: C4P6t ►coc: l:0_r 341s C Address: (4& antic 1)riW_ Address: On C itQU�Atla 1.#��t�-0i &K was issued a permit to install a (date) (installer) septic system at Ours H 2Aoe h�1'ls�A 13b based on a design drawn by ddress) Sfl ,//� dated � IlqkW6 / (designer) ✓/ I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the . distribution box and/or septic tank. Strip out (if required) was inspected and the soils ;i were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was construe--i ne �i the terms of the I\A approval letters (if applicable) ��N',,OF• MSS T,J sue( A �Iustaller's Si ture) 1 (Designer's Signature) (Affix Desig p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\besigrier Certification Form Rev 8-14-13.doc • , lua3� Town of.Barnstable....... .. �p IKE o Department of Regulatory Services BARNSM13 E,* Public Health Division Date 13 �jv MASa. 0P - ' 200 Main Street,Hyannis MA 02601- - Date Scheduled I Time M Fee Pd. t"" T z t M W Soil Suitability Assessmen-t for Sewage Disposal, a Performed By.T{A'Y) 1lA'Q(�!W l�SG O Witnessed By: fi1�t 'Vl ✓1 �yfir^� r :LOCATION&GENERAL INFORMATION Location Address 55�p,?t.j7�N�Y nliN �.n�� Owner's Name 3p��l (? 2EE, 'EWEW[Wl.LLIF, HPt&2—3Z Address iJ�cJN f'rnt.� Assessor's Map/P r el: `l JQ`L'4 Engineer's Name t UMI WIC4Z I g0l NEW CONSTRUCTION, REPA, Telephone# SV9-292.—2.9W Land Use RFC Slopes(%) '� O/' Surface Stones Distances from: Open Water Body 7 300 ft Possible Wet Area 7100 ft Drinking Water Well 7 t DO ft - .Drainage Way f[ Property Line f[ Other ft SKETCH:(Street name,dimensions of lot,exact locations of test holes&Pere tests,locate wetlands in proximity to holes) , - �4izi { 23'40244, 65 Jf . -- 21 Parent material(geologic) (51 Ole I oVI�'l. Depth to Bedrock 7 50 Pr - Depth to Groundwater: Standing Water in Hole: .NOIJE. Weep(ng from Pit Face IJONE Estimated Seasonal High Groundwater1,eA• _ 1�� DETERMINATIO�N!FOR SEASONAL HIGH WATER.TABLE Method Used: 00�2YVOltlfal ldSCiS£$liM�h2- Depth Observed standing in obs.hole: in. Depth to soil mottles: in. . Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well �Reading Date: 1 Index Well level Adj.factor _ Adj.Groun water Level_ PERCOLATION TEST ti tCea Time Q a.+^ Observation Hole# �' Time at 9" 411 PL . t � Depth of Pere - 3•L'LLl - Time at 6" - Start Pre-soak Time Q _IQ-l13 ar, 10'U1GN Time(9"-6") End Pre-soak (�( In t'dlilue5 Rate Min./inch L2mtn n i Site Suitability Assessment: Site Passed V/ Site Failed: Additional Testing Needed(YM) Original: Public Health Division Observation Hole Data To Be Completed on Back---------=- ***If percolation test is to be conducted within 100'of wetland,you must first.notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFOPM.DOC DEEP OBSERVATION HOLE I OG Hole# ..,1 ;P,l, o Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Graven O-S u 1`I LL GL iOYP- Friable tt i46 LS IDYK516 Friahl �A1�C ..: qqCM Oyu 61002 f DEEP OBSERVATION':HOLE'IOG Hole# ,Z Depth from^ n Soil Horizon` 'Soil Texture Soil Color Soil Other- -- Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) S L 0ya' Fr. lc MM ` . C wyRy` G NO Rd ObSUVOR ., tqb DEEP OBSERVATION HOLE-LOG Hole# U A Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) - (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Graven t � DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon=-. Soil Texture Soil Color Soil Other Surface(in.) .. - (USDA) (Munsell) Mottling "(Structure,Stones,Boulders. Consistency.%Gravel) 1' Flood Insurance Rate Mao: Above 500 year flood boundary No_ Yes J - Within 500 year boundary No ✓ Yes_ - -• - Within 100 year flood boundary No Yes Death 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 p io�ry us material?. Certification I certify that on L_lZ._q_'7'0I�q (date)I have passed the soil evaluator examination approved by the Department of En ronv5 mental Protection and that the above analysis was performed by me consistent with the required training,expertise and experience described in 310 CMR 15.017. Signature "AA aJt t.jlu&� Date Q:)SEPTI CV'ERCF ORM.DOC i ' Commonwealth of Massachusetts ;--. r. �€;� -. ,. r - � • -, R W Title 5 Official Inspection Forte Subsurface Sewage Disposal System Form -Not for Voluntary'Assessments 55 Bunny Run 1 Property Address Susan Tebo t; a Owner Owner's Name ; ,,•, , information is .1 . .required for every Centerville MA 02632 6-13-12 page. City/Town .' State Zip Code Date of.lnspection _ . fin 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. A. General Information r 1. Inspector: - . t. � _ . . r. Ci�j,i sigi^,�^, t 'f. I�`• r r r II Shawn Mce6y' Name of inspector Upper Cape Septic Services Company Name 29 Atwater Dr ,, s rr.,F ,,r Company Address E. Falmouth MA 02536 City/Town State Zip Code 1-508-495-0905 S13971 Telephone Number License Number B. Certification I certify that l have personally inspected the sewage disposal system at this addr4s and tha-�-t-�-the information reported below is true,'accurate and complete as of the time of the Rs ection The ins action was performed based on my training and experience in the proper function and`fllalntenanc Of orde sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system:' - .<.of•. i-x.i', „ e7R�t•e, Passes y 4 ❑ l ® -.,, r s ; ❑ Conditional) Passes. -f Falls— ❑ Needs Further Ev luation1by the Local Approving Authority spector's Signature Date The system inspector shall submit a copy of this inspection report to4he 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. 1 t5ins•11110 _ ,, Title 5 Official pectlon Form:Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official InspectionTorm, Subsurface Sewage Disposal System form =Not for Voluntary Assessments M 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is Centerville MA 02632 6-13-12 required for every State Zip Code Date of Inspection page. City/Town P P 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: System is in good working order with no sign of failure. B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass".section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass., Check the box for"yes", "no"or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection.-Forn� Subsurface Sewage Disposal System Forml=,Not for Voluntary Assessments M 55 Bunny Run Property Address Susan Tebo �r,C Owner Owner's Name =,.,•, r,, information is Centerville r';FG ,�o MA 02632 6-13-12 required for every , page. City/Town State Zip Code Date of Inspection U; B. Certification (cont.) ; '` B), System Conditionally'Passes (cont): , �,, s,t • E t;; ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a.broken, settled_ or uneven distribution box. System will pass inspection if(with approval of Board of Health' ❑ broken pipes) are replaced ' ❑` Y ❑` N` ❑'ND (Explain below): ❑ '- ' obstruction is removed � "-' r`r .❑ Y - ❑ N�', ❑�rND-(Explain below): distribution box is.leveled or�replacedt ❑ Y ❑tN �"❑ ND (Explain below): ...' ., r 1 .� ,t.� r^CI f•• i":.' �� 1 + a. r;�^a .::' .'Rf y-J:.:'. iv: .'•� 3•�.+ '�Err •r�F - ...r .. •' _ r .�.r. � 4C. #.ter. �. � �.' :.r.3'i•�r?: r�s '� .t�Jltx+, .:',!'".r-t i r. - y'... ,. f '.a" :I` F r • ;y r�4 t '" .. �`,t, �' ..r _ , 4 a,r+ .jt1�,, Y +.e- ❑ 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,Heatth): ❑ 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: Y` 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:' ' ' t ❑ Cesspool or privy is within 50 feet of a surface water e` ❑ "Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address Susan Tebo Owner Owner's Name - information is required for every Centerville MA 02632 6-13-12 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety.and environment: ` ' ❑' The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supplyor tributary to a surface water supply.' ❑ � The system has a septic tank and SAS and the,SAS is within a Zone 1 of a public water Supply. ❑, -. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from'a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen p nand nitrate nitrogen is equal g g q 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:- 1 stem +1 f r r D S Failure Criteria Applicable to All S Y Pp stems:Y You must indicate "Yes"or"No"to each of the following for all inspections: Yes No • f dam• ... , r , 1 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 El ® due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool Liquid depth in cesspool is less than 6" below invert or available volume is less ❑l ® than '/z day flow✓ t5ins-11/10 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts � : r- Title 5 Official Inspection. Forme w o Subsurface Sewage Disposal System.Form -Not for Vol untary'Assessments °a 55 Bunny Run Property Address �.- i Susan Tebo Owner Owner's Name information is Centerville MA 02632 6-13=92 required for every f' > page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) + Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ® Any portion of the SAS, cesspool or privy is below high ground water elevation. Any portion of cesspool or privy is within 100 feet of a surface water supply or ❑ ' ® tributaryto a surface water su� I . pP Y ❑ ® : ^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. El Z The system is a cesspool serving a facility with a design flow of 2000gpd- 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., k Yes No ❑ ❑ the system is within 400 feet of'allsurface 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 El ❑ } )I Area— IWPA) or a mapped Zone II-of a public water supply well If you have answered "yes"to any question'in Section E the system is considered a significant threat, or answered "yes in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Fora Subsurface Sewage Disposal System Form -Not for Voluntary Assessments . 55 Bunny Run ' Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. Cityfrown 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 backup? ® ❑ 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? ® 1-1 Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board•of Health. ® El 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): 2 Number of bedrooms (actual): 2 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 220 t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 6 of 17 i Commonwealth of Massachusetts 1 ,. 4., Title 5 Official Inspection Forim Subsurface Sewage Disposal System Form -Not for Voluntary Assessments. 55 Bunny Run Property Address y Susan Tebo , Owner Owner's Name information is required for every Centerville' , MA 02632 6-13-12 page. City/Town State Zip Code Date of Inspection D. System Information , -kA a ; ,,,A . Description: Number of current residents: 0 Does residence have a garbage,grinder? ❑ Yes ® No Is laundry on a separate sewage system? [if yes separate inspection-required] ❑ Yes ® No Laundry systemlinspected? wj t,, ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available (last 2 years usage (gpd)): P :, r ; `.0v Detail: Sump pump?, _, j, " , z .; ,,;..r .41^. ❑ Yes ® No Last date of occupancy: , �, 6-2012 Date Commercial/Industrial Flow Conditions: Type of Establishment: 4- Design flow(based on 310 CMR15:203): = iE Gallons per day(gpd) Basis of design-flow(seatsy/persons/sq.ft.;etc.): Grease trap present? ,, ;:, . of, , . i � +;. f ❑ Yes ❑ No Industrial waste holding tank present?,r r.rt nr: ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 7 of 17 Commonwealth of Massachusetts Title 5 Official, Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General Information Pumping Records: Source of information: Owner--pumped last year , Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Maintenance Type of System: ® Septictank, distribution box, soil absorption system. ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) o ❑ Innovative/Alternative technology:Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): .: t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 Commonwealth of Massachusetts . Title 5 Official I nspection Form Subsurface Sewage Disposal System Form -Not for;Voluntary Assessments.T 55 Bunny Run ,0 o_ a? Property Address -�t Susan Tebo � * .;,.?ta'_ Owner Owner's Name information is required for every Centerville MA 02632 6-13=12 page. City/Town State Zip Code Date oflnspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of.information: 1998 Were sewage odors detected when arriving at the site? 0 Yes ® No Building Sewer(locate on site,plan): , r ,r� ,i Depth below grade:.4: ai . fr 4- 14" feet" Material of construction: 4. z s �', ,: ,• '„ w=n ;; ,,. ,► ❑ cast iron ® 40 PVC ❑ other(explain)!_' I"Y !r n.. , ., ".t'"•, i•..,µ ..§ic K Distance from private water supply., well or suction line:" feet Comments(on condition of joints, venting, evidence of leakage, etc.): Good condition. Septic Tank (locate on site plan): - 8rr Depth below grade: r .•. :. feet • `. Material of construction: 4 . ® concrete ❑ metal ❑ fiberglass r ❑polyethylene,2;; ❑ other(explain) R If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach`a copy of:certificate) -,7C. ❑ Yes ❑ No Dimensions: t, 1500.gal Sludge depth: 1011 t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Of'icia - nspection- Fora h s Subsurface Sewage.Disposal System Form -Not for_VoluntaryAssessments M 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 ' 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 22" Scum thickness t 1" Distance from top of scum to top of outlet tee or baffle 6" a Distance from bottom of scum to bottom of outlet tee or baffle 15 How were dimensions determined? Tape Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank is in good condition with baffles installed and no sign of leakage. Grease Trap (locate on site plan): :I . 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form' ' a Subsurface Sewage Disposal System Form -Not for Voluntary Assessments', 4qM m'' 55 Bunny Run ,.. . Property Address , y-R• Susan Tebo _ Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. City/Town a, State Zip Code Date of Inspection D. System Information (cont.) 0 f:ly Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): `F <, .. I 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.): i I "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection F®rm Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): . Depth of liquid level above outlet invert 0 Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Good condition with water at working level and no sign of back-up. 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•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 i Commonwealth of Massachusetts -� Title 5 Official Inspection Forii Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address .t Susan Tebo ,,• %, Owner Owner's Name - information is required for every Centerville 3 . ,,'- MA 02632 6-13=12_, page. CftyfTown - State Zip Code Date of Inspection D. System Information (cont.) ; - =o- ► _:> .>k K :ti, . :r- . • . '1,..l.,,� an 7`i. . r; i 4.lii.f ',;.° ,,.;r •,-p rei`t. Type: ❑ leaching pits number: ® leaching chambers number: 2-Flodiffusers ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: L. 'V-- :r ❑ innovative/altemative system _ SA;E{ Type/name of technology: Comments (note'condition of soil, signs of hydraulic failure, level of ponding:'damp soil, condition of vegetation, etc.): , Flodiffuser leach field in good condition and empty at inspection with stain line at 3"from bottom of chamber. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 IN Commonwealth of Massachusetts ., Title 5 Official Inspection Form' Subsurface Sewage,Disposal System Form -Not for Voluntary Assessments 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 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.): 3 ( Privy.(locate on site plan): Materials of construction: Dimensions Depth of solids Comments (note condition of soil, signs,of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts ".• :r , °,,,;� _# ,3...,P:; Title 5 Official Inspection .For M­ s Subsurface Sewage Disposal System,Form.-Not for Voluntary Assessments`c z re 41A. 55 Bunny Run - - ; ..;..' '•: Property Address ti Susan Tebo Owner Owner's Name information is required for every Centerville t ..a:' MA 02632 6-13=.12 . page. City/Town . ;� State Zip Code . Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal,system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately C �WR.a j,••1 = rl,{.t'�t." f.�^���'t�.['f Y a...a'Ctrz}r - Pl i t' ,r7 "t.s a .. . �, «.F..',1, •:1. ., f'+ a rzw ,` 4 .. w #_. �. ; r 7,2I6 d i }F�,• •:r l�1: Ltti; '� "r. ,fir �°t6x .r;z�?+��1f•t"' t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form` Subsurface Sewage Disposal System Form -Not for Voluntary Assessments, 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. Cityrrown State Zip Code Date of Inspection F D. System Information (cont.) Site Exam; x. ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10, feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked, date of design plan reviewed- Date ® Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health -explain: ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database- explain: You must describe how you established the high ground water elevation: Original design plans show no groundwater at 10'. r Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-11/10 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments ` 55 Bunny Run Property Address Susan Tebo Owner Owner's Name information is required for every Centerville MA 02632 6-13-12 page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ® System Information—Estimated depth to high groundwater. ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file �I t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 TO'%)N OF BARNSTABLE f—k , 'LOCATION �S 4 L.n n WC4 on SEWAGE # r VILLAGE ASSESSOR'S MAP&LOT - INSTALI.ER'S N •&PHO NO_ SEP*nC TANK-CAPACIT4' y LEACHING-FACHM: (tygc) r 111 C6 44 u/3 (size) NO.OFBEDROOMS BUILDER OR OWNER pERMITDATE: COMPLIANCE DATE; 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 vAthin 200 feet of lmhing facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet o leaching facility) Feet Furnished by � u�'�^ �� /� 1 - - r r E c ,- Li A D- 5(2'6 '' TOWN OF BARNSTABLE 1: LOCATION -A—V U SEWAGE # VILLAGE � �`- `z lit , C ASSESSOR'S MAP&LOT 3 Ll 6x�( INSTALLER'S NAME&PHONE NO. e .— SEPTIC TANK CAPACITY LEACHING FACILITY: (type) 4 (size) NO.OF BEDROOMS BUILDER OR OWNER i�� '"d ''`f i' PERMITDATE: COMPLIANCE DATE:f=/a-'g r7 Separation Distance Between the: Maximum Adjusted Groundwater Table to/teottom of Leaching Facility Feet Private Water Supply Well and.Leachi Facility (If any wells exist on site or within 200 feet of leac ' g facility) Feet Edge of Wetland and Leaching F ility(If any wetlands exist within 300 feet of leaching facility) Feet Furnished by ` - o A - � �+ 3` _ � \� -Q a � ��.__ � Q ed r , �� . , � � !' nay • No. � Fee 5 0 .THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE., MA CHUSETTS 0[pprication for Di_4pozal *potem Construction Permit Application for a Permit to Construct( )Repair(X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Rrswner's N Address and Tel.No. 55 Bunny Run Road., Centerville , S . Fleming Assessor'sMap/Parcel mA 55 Bunny Run Road, Centerville , MA InWl r''eame,O�`n s o n 1 e pt i c System Designer's Name,Address and Tel.No. uP.O . Box 1089 , Centerville , MA Type of Building: Dwelling No.of Bedrooms 2�3 Lot Size sq.ft. Garbage Grinder( ) Other Type of Building No. of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow gallons per day. Calculated daily flow gallons. Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil S and. Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 septic system 1 , 5000gal tank and. 2 precast leach chambers . 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 Certifi- cate of Compliance has been issued by this ar f Health. Signed /. G ` Date Application Approved b " Date Application Disapproved for the following reasons Permit No. - Date a_­­ed .e- _! Fee $5 0 .: No. r` Y THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION -TOWN OF BARNSTABLE, MAS CHUSETTS 2pprication for -Migpo5af bpgtem Construction Permit Application for a Permit to Construct( )'Repair( X)Upgrade( )Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. er's N Address and Tel.No. 55 Bunny Run Road., Centerville, Ws . �eming Assessor'sMap/Parcel 55 Bunny Run Road., Centerville, MA MA �' Injf ller' IameR 0 1T15 Onl 0e pt i s System Designer's Name,Address and Tel.No., P.O. Box 1089 , Centerville , MA Type of Building: Dwelling No.of Bedrooms 2/3 Lot Size sq.ft. Garbage Grinder Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures a Design Flow gallons per day. Calculated daily flow gallons. e Plan Date Number of sheets Revision Date Title Size of Septic Tank Type of S.A.S. Description of Soil Sand Nature of Repairs or Alterations(Answer when applicable) Install new Title 5 septic system 1 , 50009al tank and. 2 precast leach chambers . Date last inspected: Agreemen't/ The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the Environmental Code and not to place the system in operation until a Certifi- cate of Compliance his�ar ce has been issued by t f Health`. cr Signed "- Date Application Approved by` ? r j� r�. Date ApplicationfDisapproved for t e following reasons } Permit No. ':' bate--Issued. THE COMMONWEALTH OF MASSACHUSETTS Fleming BARNSTABLE, MASSACHUSETTS (Certificate of (Compliance THIS IS TO C TIFF tha th On-site Se a is osal System Constructed( )Repaired( X)Upgraded( ) Abandoned( )by "J' te ob `mnson p a 1pC 6ervlce at 55 Bunny Run Road , C.entOrville , MA has been constructed in accordance with the provisions of Title 5 and the for D��tspp99 System C tructio��ermit No , dated Installer Wm. E.. R obci s o�nf pt`iZ, .ry. Design' _i 4 The issuance of this permit shalbnot be construed as a guarantee that the system 'll fun on as designed. Date Inspector ---- ----------------------------------- $50 No. "� _ _ _-.. ,. Fee _ Fleming '�_k THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS Mioogal *p!tem Construction Permit Permission is hereby granted to Construct( )Repair( X)Upgrade( )Abandon( ) System located at 55 Bunny Run Road., Centerville and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must be completed within three years of the date of this l/ i� > Approved b Date: d' ,••' ,!� --� ''�•--���t��� �1 i�'..�'-�"�" ', lJ ,a NOTICE: This Form Is To Be Used For The Repair Of Failed Septic Systems Only. CERTIFICATION OF SKETCH AND APPLICATION FOR A DISPOSAL WORKS CONSTRUCTION PERMIT (WITHOUT ENGINEERED PLANS) ,I, William E. Robinson, Sr. ,hereby certify that the application for disposal works construction permit signed by me dated y concerning the property located at 55 Bunny Run Road, Centerville., MA meets all of the following criteria: *here are no wetlands within 100 feet of the proposed leaching facility. *"Where are no private wells within 150 feet of the proposed septic system. * 76re is no increase in flow and/or change in use proposed. * T ere are no variances requested or needed. * he proposed leaching facility will be located with 250 feet of any wetlands,the bottom of the proposed leaching facility will not be located less than fourteen(14)feet above the maximum adjusted groundwater table elevation. Please complete the following: A)Top of Ground Elevation(according to the Engineering Division G.I.S. map) B)Observed Groundwater Table Evaluation(according to Health Division well map) SIGNED: DATE LICENSED SEPTIC SYSTEM INSTALLER IN THE TOWN OF BARNSTABLE NUMBER 60 (Attach a sketch plan of the proposed system. Also if the licensed installer posesses a certified plot plan, this plan should be submitted). �VIIA) l S NOTES:- _._ ... LEGEND: - 55 BUNNY RUN 1.CONTRACTOR TO VERIFY LOCATION OF EXISTING SEPTIC COMPONENTS PRIOR LOCUS: - - EXISTING CONTOUR TO STARTING WORK. BARNSTABLE, MA ..- -- EXISTING UTILITIES 2.ADD NEW OUTLET TO EXISTING 1500 GALLON TANK NEW LINES.DISTRIBUTION , , , MAP 234 PARCEL 024 PLANTING BOX ON STABLE COMPACTED BASE,AND SAS ACCORDING TO PLAN. LOT#30- 17,920 S.F. f SV ...PROPOSED,CONTOUR 3.ALL CONSTRUCTION TO BE MINIMUM OF 10 FT FROM PROPERTY LINE. i JOHN P. FRAZEE { TEST PIT LOCATION - 1 OWNER: j 4.BACKFILL MUST BE CLEAN AND FREE OF STONES>6"IN SIZE,TAILINGS,CLAY, DEED REF: BOOK 26600 PG 168 OR SIMILAR PROHIBITED MATERIALS. PLAN REF: BOOK 172 PG 51 5. NO IMPERVIOUS AREAS SHALL BE PLACED OVER SAS UNLESS IN ACCORDANCE ' WITH 15.241. 1. LOCUS DOES NOT FALL WITHIN A FEMA SPECIAL 6.ALL SOIL ABSORPTION SYSTEMS SHALL HAVE A MINIMUM OF ONE INSPECTION FLOOD HAZARD ZONE. PORT WITH 3"OF FINISHED GRADE CONSISTING OF A PERFORATED 4"PIPE 2. NO WETLANDS WITHIN 100 FT OF PARCEL. PLACED VERTICALLY DOWN INTO THE STONE OR THE NATURALLYL OCCURING SOIL.THE PIPE SHALL BE CAPPED WITH A SCREW TYPE CAP AND ACCESSIBLE TOI 3. LOCUS IS WITHIN A ZONE II OF A PUBLIC WATER SUPPLY WELL. . l 4. PROPOSED SYSTEM IS FOR UPGRADE OF EXISTING SYSTEM ONLY. NO INCREASE IN DESIGN FLOW IS PROPOSED. N 5.ALL ELEVATIONS BASED ON ASSUMED DATUM. 1� awl Sri BENCHMARK BENCHMARK T.O.F. ELEVATION=t 57.4' 6. DWELLING IS SERVED BY MUNICIPAL WATER. t 0 7. IT SHALL BE THE RESPONSIBILITY OF THE i E `'I CONTRACTOR TO VERIFY LOCATION OF ALL ` UTILITIES PRIOR TO STARTING WORK. 8.THIS PLAN IS TO BE CONSIDERED FOR SEPTIC a 17 9SYSTEM PURPOSES ONLY AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY. -S, 9.ALL AREAS DISTURBED DURING CONSTRUCTION SHALL BE RESTORED TO A CONDITION AGREED �2 UPON BY THE OWNER AND THE CONTRACTOR. y5Z \ P Pq� SEPTIC REPAIR/ UPGRADE PLAN AT: \\ 4 S,9.S SIB rl '!►1 55 BUNNY RUN p a t BARNSTABLE, MA ' 73' = _ PREPARED FOR: j JO HN P. FR AZEE IL OF TER RI y A. \ GUA Q GUARINO SANITATION SERVICES !` LOCUS MAP (NOT TO SCALE) \ / R S N\ 346 MISTIC DRIVE \ MARSTONS MILLS,MA 02648 + (508)292-2848 I REV. DRAWN: CHECKED: DESCRIPTION: No 1 t � ag tag upgrade SAS I 1216 D0ttE-'FEB.1°t,Zo t1'J SHEET 1 OF 2 SCALE: 1 INCH = 20 FT. r 0 10 20 40 80 FEET i THREE MANHOLE COVERS. BRING A hJIhUA OF ONENOTES: NOTES: _ COVER TO WITHIN 6" OF FINISHED GRADE. BRING OTHER 1. SEPTIC TANK SHALL BE EMBOSSED Vil S �L COVERS TO WTHIN 12" OF FINISH GRADE- yTA TINE COVrUrihIANCE Y/ITH .ASTa1 C 12 1. UNLESS OTHERWISE NOTED,ALL SYSTEM TOP C`� FOUNDATION 27 94. ( TH OF 4.8E ACC LEACHING ER-CH NIS COMPONENTS AND CONSTRUCTION METHODS SHALL E1 FV _ _.._. ..__- - -- _ ._. _ _....._ .___ _2. .CORROSION RESISTANTGAS BAFFLE SHALL BE 1 4�i1TH�/r„INIUUM) ONE ACCESS PORT PER CHAMBER ...__...._ 5�y - -• . - BE IN ACCORDANCE WITH TITLE 5 OF THE STATE INSTALLED ON SEPTIC TANK CUTLET TEE. ENVIRONMENTAL CODE AND ANY APPLICABLE TOWN I OF BARNSTABLE REGULATIONS. 2.ANY CHANGES TO THIS PLAN MUST BE APPROVED HEALTH AN DESIGN PVC - _ _ - � • - .; :... 2" OF 1/8"-1/2" BOARD OF AND l.� BY THE BOA EAL SIG SEr4FR.LINE DOUBLE V/ASHED PEASTON= ENGINEER. "PVC @t27 �� TO OF PEASTOi tE ELEV ` GARBAGE 4"PVC 2� P 3,THIS SYSTEM I NOT DESIGNED FOR A - - G- a" o' SUMP , TE S N -� 00 GALL v PVCC,. F.G.= �55a @2%• ' q'` )( DISPOSAL. INV_ IN 1,500 GALLON Z% � 4' 4' ►/1►N MEE 3 ± N SEEP TIC TANK INV. OUT - 4" o TYP. CO�R OVERSP►$ V. -LPVC @ 2% row$3• 4. NOTIFY THE DESIGN ENGINEER AND BOARD OF KIFfP LW c a o 'c c g o c o o a rn c o 0 0 0 HEALTH IF UNSUITABLE SOILS ARE PRESENT. C o0G1 o;st1 c 21:1; op as o 0 0 < IyV Iu ;o°, o o d o c o 0 0 o c o 0 0 o c o o �_>oo EXCAVATE COBBLES AND UNSUITABLE MATERIAL °°f]o O� oD oa INV. INJ Aon o WITHIN 5FT OF SOIL ABSORPTION SYSTEM AND 523�. ' - *LE\,-L STABLE 6" 52•{0 }I-10 aV.nl IT = Fr' I REPLACE WITH TITLE 5 SAND IF NECESSARY. CRUSHED STONE SASEE--- 080X ' `1 20 �•W3 tJ0 G4�uNt JA 80TTOh1 NCI 3/4" - 1-1/2" DOUBLE 5.THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE 3" PAIN. t --'1 @?A.y6.0 ' `,'/ASHED CRUSHED STONE ei. +Sa•37 c' +ur BACKFILLED PRIOR TO INSPECTION AND APPROVAL F I.L1 I_ � 1 T I /SUSEEP I CONCRETE PRODUCT, INC. 15G0 GAL l � I -1 SEP TIC TANK OR APPROVED EQUAL BY THE BOARD OF HEALTH AND THE DESIGN E" PAIN. (E�l$;INCo) ENGINEER. 2" MIN. �tD N�., OU1LET VI1T1-� {- CORROSION` / SION RESISTANT T GAS BAFFLE t?L' Gt=YLUEPJi FIt-1 GR 10 WIN. 14" 6.THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR � MIN TYPICAL 7- SRE►�KouT tL53.3 '�I1�ITAI►`j THE FAILURE OF THE CONTRACTOR OR OWNER TO " = I YP I C A L SEPTIC SYSTEM,.; PROFILE NOTIFY THE LOCAL BOARD OF HEALTH FOR PROPER 2 N-10 �00 G-�LL✓�PQtECr�Si L67"it0 Ch'r1+�1�>rt�Z.S � 15vf• LA -ALL 6tiY°NO SAS INSPECTIONS DURING CONSTRUCTION. . ____. , ,, , •"_, . __,. •-._ 7.ALL SYSTEM COMPONENTS TO BE WITHIN 36"OF FINISHED GRADE. SOIL AND PERCOLATION DATA DESIGN CALCULATIONS: 8.ALL PIPES SHALL BE 4"SCHEDULE 40 PVC @ 2% DATE:January 27,2016 SLOPE (UNLESS SPECIFIED). TAKEN BY:Terri Guarino,IRS,CSE NUMBER OF BEDROOMS: 3 WITNESSED BY David W.Stanton,RS ` 9. DOUBLE WASHED CRUSHED STONE SHALL BE FREE SOIL TEXTURAL CLASS: CLASS I LTAR: 0.74 GPD/SQ FT PERC RATE:<2 min/inch OF ALL DIRT, DUST,AND FINES. See attached soil suitability assessment form PERCOLATION RATE: MIN/INCH N BOX AND SAS SHALL BE DESIGNED 10. DISTRIBUTIO SEPTIC TANK: 660 GALLONS REQUIRED USE EXISTING 1500 GALLON TANK TEST HOLE 1 EL.1:56.0 �TEST HOLE 2'EL. t56.3 TO WITHSTAND H-10 LOADING. 0° FILL 0" FILL DESIGN FLOW 110 GPD/BEDROOM x 3 BR=330 GPD <p 1 REQUIRED: , v,. 11. EXISTING PRECAST SAS TO REMAIN. y 8". Ab 12" Ab LEACHING AREA yQ Tsvt}1 �y�'. 12.ADD NEW OUTLET TEE TO TANK WITH GAS BAFFLE SANDY LOAM 10YR 3/2 SANDY LOAM 10YR 3/2 REQUIRED Fri 446 SQ FTC A. i OR APPROVED EFFLUENT FILTER AS SHOWN ON PLAN. i c GUAf a" ,s" USE 2 H-10 500 GALLON PRECAST LEACHING CHAMBERS WITH `> 13. SAS TO HAVE ONE INSPECTION PORT WITH COVER gg B B 4 FT 3/4"-1 1/2"STONE AROUND ALL SIDES ` t/ \Q ACCESSIBLE WITHIN 3"OF FINISHED GRADE. 'PERC LOAMY SAND.1 0YR 5/6 LOAMY SAND 10YR 5/6 12.83 FT wide x 25 FT long x 2 FT effective depth S0 14. MARK ALL SYSTEM COMPONENTS WITH MAGNETIC TAPE. 15%GRAVEL 15%GRAVEL BOTTOM AREA: 12.83 FT x 25 FT=321 SQ.FT 15. CONTRACTOR TO VERIFY EXISTING INVERT aa" 53" SIDE AREA: (25 ELEVATIONS PRIOR TO STARTING WORK. FT+ 12.83)2x2FT= 151.3SQFT C C TOTAL LEACHING 16.ALL AREAS AND LANDSCAPE FEATURES AREA: 472 SQ FT DISTURBED DURING CONSTRUCTION SHALL BE MEDIUM SAND WITH COBBLES MEDIUM SAND WITH COBBLES RESTORED TO A CONDITION AGREED UPON BY THE DESIGN FLOW: 472'$Q FT x 0.74 GPD/SQ FT=349-GPD 1 OYR 4/6 15% GRAVEL 10YR 4/6 15%GRAVEL - /""- OWNER AND THE CONTRACTOR. OTHER NOTES: S 120" ,zo" _ -- - - Obt/ZJ'li +n eilrnSfable �.lT wi�-h ' NO GROUNDWATER NO GROUNDWATER 2" CF 1 8" -1 2" oo• __......_._...._._..__...---......_._ _...-_. ...__..__.._ .._...._ __, DCU __ VlAS ,_ j 1 �,.� HE C� 'Ilea �nai l.� SS 'PERC TEST HOLE#1 @ 32"-44"in B Layer .4' (TY?) `4'(TYP) /H-AJGRAVEL Start Pre-soak 10:03am-10:07am:24 Gallons Water �R r,LZtFZr3+C I 1:::-:>.:_:-.•-.i c:.,:�.:�..•_� SEPTIC REPAIR PLANAT. Perc rate<2 min/inch LTAR=0.74 GPD/SCI FT Class I Soil j I o I r�\ L1= ;� f I?!V=-T Q O �] a 4< cz Z/4" TO 1-1/2" , TAPER 5 BUN UN 35 ^� c. e, ", eOS, °� DOUBLE VAS_ED STONEBUNNY iI �4' I �� G O�OD CENTERVILLE, MA02632 I certify that I am currently approved by the Department of I; v ? �'�eE Oc FItv'ES ® ® . C] - Environmental Protection pursuant to 310 CMR 15.017 to conduct I i ® I ® ®® ®� PREPARED FOR: soil evaluations and that the above analysis has been performed by 1 e ® ®®® s me consistent with the required training,expertise and experience a'_ '6 ®® � described in 310 CMR 15.017. 1 further certify that the results of my 4'-C JOHN FRAZEE�- �O 4'-O" soil evaluation, as indicated are accurate and in accordance with 310 C__ \ ® GUARINO SANITATION SERVICES CMR 15.100 through 15.107. 346 MISTIC DRIVE '�(\ 4 P,IiND,,UyI MARSTONS MILLS,MA 02648 2$ 201 y 1 ,J� I - SEPARATION' ION' DAT OFE MINATION SIGN UREOFSOILEVALUATOR ~ - DISTANCErJOOGALLON (508J292-2848 DI( Te ri A.Gya no U770 + AIA gyp. yb.o1 FRD,,, _ DATF I PRINTED NAME/LICENSE# I - N�N>;@� G OUNDV/ATGR PRECAST LEACHING CHAMBER �os#1216 DATEIZEV 2•Ill.16 SHEET 2OF2