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HomeMy WebLinkAbout0031 CEDAR POINT CIRCLE - Health 31 Cedar Point Circle, Centerville 8 - 113 - 004 A= 22 4 k t a `t ti M Sllll �QE`""F0C � oy� O i i IIu UPC 12543 No. 53LOR C�POn•CQNS°�� HASTINGS. MN �I 9 F 5 4 i 3 _ _ f_. �. a Re- IS-004 Commonwealth of Massachusetts Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form-Not for Voluntary Assessments y 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is Centerville ✓ Ma 02632 3/5/2021 required for every page. Cityrrown 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:out forms n A. Inspector Information �'l 15�1 filling out forms � on the computer, use only the tart Sean M. Jones key to move your Name of Inspector cursor-do not S.M.Jones Title V Septic Inspection use the return Company Name 4 key. 74 Beldam Lane � Company Address Centerville Ma 02632 Citylrown State Zip Code 774-248-4850 smjonestitle5@gmail.com, SI4522 sean@smjonestitle5.com License Number B. Certification I certify that: I am a DEP approved system inspector in full compliance with Section 15.340 of Title 5 (310 CHAR 15.000); 1 have personally inspected the sewage disposal system at the property address listed above;the information reported below is true, accurate and complete as of the time of my inspection; and the inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems.After conducting this inspection I have determined that the system: 1. ® Passes 2. ❑ Conditionally Passes 3. ❑ Needs Further Evaluation by the Local Approving A 4. ❑ Fails 3/5/2021 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or CEP)within 30 days of completing this inspection. If the system has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original form should be sent to the system owner and copies sent to the buyer,if applicable, and the approving authority. Please note:This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5lnsp.doc•rev.7/26/2018 TRIe 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 18 J c Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. Citylrown state Zip Code Date of Inspection C. Inspection Summary Inspection Summary: Complete 1, 2, 3,or 5 and all of 4 and 6. 1) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist.Any failure criteria not evaluated are indicated below. Comments: The property located at 31 Cedar Point Circle Centerville is served by a Title V septic system consisting of a 1500 gallon septic tank, distribution box and 3 500 gallon precast leach chambers. Although the system was found to be in proper working condition at the time of inspection this report does not guarantee future performance under similar or increased usage. 2) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair, as approved by the Board of Health,will pass. Check the box for"yes", "no"or"not determined"(Y, N, ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance.indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): t5insp.doc•rev.7f2812018 Trite 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments, -v 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. City/Town State Zip Code Date of Inspection C. Inspection Summary (cont.) 2) System Conditionally Passes(cant.): ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): 3) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. a. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: t5insp.doc•rev.7r2MO18 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 18 - `-\ Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. City1rown state Zip Code Date of Inspection C. Inspection Summary (cost.) ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh b. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning In a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well**. Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. c. Other: 4) System Failure Criteria Applicable to All Systems: You must indicate"Yes"or"No"to each of the following for all inspections: Yes No El ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool t5insp.doc•rev.MUM 8 Tale 5 Official Inspection Form:Subsurfeoe Sewage Disposal System•Page 4 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle lug Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. City/Town state Zip Code Date of Inspection C. Inspection Summary (cont.) 4) System Failure Criteria Applicable to All Systems: (cont.) Yes No El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6"below invert or available volume is less than%day flow ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public water supply well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000 gpd- 10,000 gpd. ❑ ® The system 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. 5) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section C.4_ 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 PPe t5insp.doc•rev.7/CM18 Title 6 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 18 Commonwealth of Massachusetts lipTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page, Cityfrown State Zip Code Date of Inspection C. Inspection Summary (cost.) If you have answered"yes"to any question in Section C.5 the system is considered a significant threat, or answered"yes"to any question in Section CA above the large system has failed. The owner or operator of any large system considered a significant threat under Section C.5 or failed under Section CA shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 6. You must indicate"yes"or"no"for each of the following for all inspections: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] i I t5insp.doc-rev.7/2612018 Title 5 OfFldal Inspection Form:Subsurface Sewage Disposal System•Page 6 of 18 Commonwealth of Massachusetts ve Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. CityfTown State Zip Code Date of Inspection D. System Information 1. Residential Flow Conditions: Number of bedrooms(design): 4 Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 440 gpd Description: Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Does residence have a water treatment unit? ❑ Yes ® No If yes, discharges to: Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available(last 2 years usage(gpd)): Detail: Sump pump? ❑ Yes ® No Last date of occupancy: currentDate t5insp.doc•rev.7@812018 rifle 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 2. Commercial/industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Water treatment unit present? ❑ Yes ❑ No If yes, discharges to: Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: Last date of occupancy/use: Date Other(describe below): 3. Pumping Records: Source of information: Was system pumped as part of the inspection? ❑ Yes ® No If yes,volume pumped: gallons How was quantity pumped determined? Reason for pumping: t5lnsp.doc•rev.712=18 Title 5 official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Nam information is Centerville required for every Ma 02632 3/5/2021 page. Cityrrown State Zip Code Date of Inspection D. System Information (cunt.) 4. Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system(yes or no)(if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system.owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components,date installed(if known)and source of information: system installed 2/W017 per town records Were sewage odors detected when arriving at the site? ❑ Yes ® No 5. Building Sewer(locate on site plan): Depth below grade: 2.5feet 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.): Joints in good condition, no leakage,vented through roof. . t5insp.doc•rev.7/26=18 Idle 5 Ofriaal Inspection Form:Subsurface Sewage Disposal System•Page 9 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) 6. Septic Tank(locate on site plan): Depth below grade: 2 feet Material of construction: ®concrete ❑ metal ❑fiberglass ❑polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance?(attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1500 gallons Sludge depth: 5" Distance from top of sludge to bottom of outlet tee or baffle 3' Scum thickness 2° Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle 101, How were dimensions determined? Opened covers and took measurements Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tank does not need to be cleaned now but should be done soon and again every 2 years for proper maintenance. Water level was even with outlet, tank was not leaking and was structurally sound. Inlet and outlet covers are to grade. t51nsp.doc•rev.7/26=18 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owners Name information is required for every Centerville Ma 02632 3/5/2021 page. City/Town state Zip Code Date of Inspection D. System Information (cont.) 7. Grease Trap(locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): 8. Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day t5nsp.doc-rev.7/28/2018 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 18 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. Citytrown State Zip Code Date of Inspection D. System Information (cont.) 8. Tight or Holding Tank(cont.) Alarm present: ❑ Yes ❑ No Alarm level: Alarm in working order. ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches,etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No 9. Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0" Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc_): Distribution box was video inspected and found level and in good condition with no rot.Water level was even with outlet invert with no signs of past backup. t5insp.doc-rev.MUM 8 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 10. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances,etc.): *If pumps or alarms are not in working order, system is a conditional pass. 11. Soil Absorption System(SAS)(locate on site plan, excavation not required): If SAS not located, explain why: Type: ❑ leaching pits number. ® leaching chambers number: 3x500 gallons ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number. ❑ innovative/altemative system Type/name of technology: t5insp.doc•rev.7/2U2018 Idle 5 official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 CityfTown page. State Zip Code Date of Inspection D. System Information (cunt.) 11. Soil Absorption System(SAS) (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation,etc.): s.a.s.consists of 3 precast leaching chambers in a 32'xl 3'x2'trench. Leaching facility was video inspected from vent and found dry with no signs of past overloading. 12. Cesspools(cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes. ❑ No Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5insp.doo•rev.726=18 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System-Page 14 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owners Name information is required for every Centerville Ma 02632 3/5/2021 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) 13. Privy(locate on site plan): Materials of construction: Dimensions Depth of solids --- Comments(note condition of soil,signs of hydraulic failure,-level of ponding, condition of vegetation, etc.): t5insp.doc•rev.7/26=18 Title 5 Official Inspection Form:Suosurface Sewage Disposal System•Page 15 of 18 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Ownets Name inforrequired is Centerville Ma 02632 3/5/2021 required for every page. citylrown State Zip Code Date of Inspection D. System Information (cont.) 14. Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately j `let r� rr 4: l ell 13: g. s" I' tsrtrep doc-rev 7/2tr ma TNe 5 Oficiei Inspection Forth:Subsurface S swage Dispose!System•Page 16 of 18 i Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address Geor e&Margaret De esso Owner Owner's Name information is tery Cenille required for every Ma 02632 3/5/2021 page. Cityrrown state Zip Code Date of Inspection D. System Information (cont.) 15. Site Exam: ® Check Slope ® Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 12'+ feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) ❑ Accessed USGS database-explain_ You must describe how you established the high ground water elevation: Groundwater was established by accessing town of Barnstable groundwater contour maps. Before filing this Inspection Report,please see Report Completeness Checklist on next page. t5insp.coc•rev.7P2612018 Title 5 Official inspection Form:Subsurface Sewage Disposal System•Page 17 of is i Commonwealth of Massachusetts lugTitle 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle Property Address George&Margaret Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 3/5/2021 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist Complete all applicable sections of this form Inclusive of: ® A. Inspector Information:Complete all fields in this section. ® B. Certification: Signed& Dated and 1, 2, 3, or 4 checked ® C. Inspection Summary: 1, 2, 3, or 5 as completed appropriate P 4(Failure Criteria)and 6(Checklist)completed ® D. System Information: For 8:Tight/Holding Tank—Pumping contract attached For 14: Sketch of Sewage Disposal System drawn on pg. 16 or attached For 15: Explanation of estimated depth to high groundwater included t%W.doc•rev.7I2812018 Title 5 OfWal Inspection Form:Subsurface Sewage Disposal System•Page 18 of 18 No. .� � Fee THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes 9ppliLation for Mispo8al 6pstrm Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade X Abandon( ) R/Complete System ❑Individual Components Location Address or Lot No. 3) Cgdas i n+— 0-1 tr,,2 Owner's Name,Address,and Tel.No. Sa$-t$;)- '9 O t($ ,M AGev V4 �P .c - 313 Assessor's Map/Parcel aa$ // bats Installer's Name,Address,and Tel.No. 5U$-90I-`J 3 9 9 Designer's Name,Address,and Tel.No.-53{- 4o-33i1 &A.O(61 �hSMuc�-avn;3nc• �ls lush-c��� } Sans, Lnc R6,Q1-6x `t-$'I Type of Building: e�rV; 3 Y��itnv,�sr1� Dwelling No.of Bedrooms Lot7 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 Number of sheets � Revision Date Title �P . ��me�, PL,, tLjL 31 ��A;4 E OaeY n/-z& A Size of Septic Tank-1 u-/ 64,I6) l r le- Type of S.A.S. 3- 4c"3o 4GGPC&477 dJ�/'3 X 3 a Description of Soil 6e,� 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 t to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt Si d Date 7 If Application Approved by Date Application Disapproved by Date for the following reasons Permit No. �� Date Issued s No. r/ / Fee � THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: V PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes application for disposal 6pstem Construction permit Application for a Permit to Construct( ) Repair( ) Upgrade'X Abandon( ) ®Complete System ❑Individual Components Location Address or Lot No.3) Wctf- ii Owner's Name,Address,and Tel.No. .5-uS-ci S a- `�U L/1 'r. Assessor's Ma /Parcel mlg /� 0-e4�`�'.-�Ui i�2 ,�1 , �'`F �y �E e .3I�J p ,2 a-4r) A6`� )c AA . 0P,S9 Installer's Name,Address,and Tel.No. SUS•77(-1 3 9 Designer's Name,Address,and Tel.No._5 F• _--to-3311 [3or}v(a Cbhs�ruc�ior, nc• Sl5�rclusfr-LI fZ� !Lt¢ 1- 50") Lrc �, n�k 761 i 115 V fa F nc e. + i� U7 S-3'7 Type of Building: (1 eY�s�; 3 �1�xEuv, 5���-, Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder( ) i Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.required) gpd Design flow provided YW gpd Plan Date L/a /��* nn //�N(umber of sheets Revision Date //� Title 3 fJ .S,,4 ne S e1Yr�� 40LAI el- `�! ��iin �,/�i n � r/nrY t CQ ,f tpJ1,//LX..t�O Old 6 0 �� / 1 - 1 / j /' Size of Septic Tank /S�p�,p 64,/U� Tom k- Type of S.A.S. 3- 149b Ss >rt�e� frc:�17C1Cli�IJ /3 X 3 9L S�ii7jE..JI,[.f� Description of Soil 4•1_Qy�;��, � /01.;:2 Nature of Repairs or Alterations(Answer when applicable) iy 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 riot to place the system in operation until a Certificate of Compliance has been issued by this Board of Healt . Sign d Date 7�! , Application Approved by Date G Application Disapproved by Date for the following reasons - i Permit No. r "U Date Issued Y ------------------------------------------------------------------------------------------------------------------------- ---- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTIFY,that the On-site'Sewage Disposal system Constructed( ) Repaired( ) Upgraded 06 Abandoned( )bynOr �_1_rL at j �� n , T"n c n - ��t. n Le� t)i I/ E has been constructed in accordance l with the provisions of Title 5 and the for Disposal System Construction Permit No:;b17-CUl6' dated 1 9/) - Installer QDo b 16_c OU D-sA n sC F(an 1 Inc Designer MCt..y_", �- `co S U #bedrooms �3C_AA V1n Approved design_kow Y yU gpd The issuance of is pelrmit shall not be construed as a guarantee that the system wi.1 functibn f designed. Date Inspector „/ ►� \ i - --------------------------------------------------------------------------------------------------------------------------------------- No. I — Fee /5 THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION- BARNSTABLE,MASSACHUSETTS 33isposal 6pstetn ConstrUrtion permit Permission is hereby anted to Construct Repair Upgrade Abandon System located at 3 1 C.[°dot_r" Po i n f n/t_ \ e n f-F r•U I t le_ fi and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construction must)be com leted within three years of the date of this pe it. Date J ) Approved by Town of Barnstable `"E'O Regulatory Services Richard V. Scali, Interim Director * BARIVSTABLE Public Health Division 1639' ♦0 '°�Ec one- Thomas McKean, Director 200 Main Street, Hyannis, 1VIA 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permit# p1 '� -o �a Assessor's Map\Parcel ;Q� Designer: P e,4"-* Installer: &z9p mi Address: P© sN 9 y Address: Flo, k % �, ,��-�nl�►�Il I GPI , MAAS On 9 �� ' 'was issued a permit to install a (date) /�� (insta er r septic system at 3 l� r Y��C-Cl�`'�'t based on a design drawn by (address) / v dated (de igner D.1 rYt"�'-, 04A- I certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by de igner to follow. Strip out (if required) was inspected and the soils were found satis ry. I certi at e system referenced above was constructe e with the terms oft \A proval letters (if applicable) ��pp Q�(j 1 DARp�K N F 11n ` i iY1� R \ Inst ler's Signature^ 1W + ci (Designer's Signature) (Affix Designer amp Here) 4r PLEASE RETURN TO B STABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORM AND AS- BUILT CARD ARE RECEIVED BY THE BARNSTABLE PUBLIC HEALTH DIVISION. THANK YOU. Q:\Septic\Designer Certification Form Rev 8-14-13.doc TOWN.-OF BARNSTABLE LOCATION,�I C.0 Z�c�t��� SEWAGE# 14 17-C% VILLAGE Corr, r-.. 1(- ASSESSOR'S MAP&PARCEL 9_ t L3 INSTALLER'S NAME&PHONE NO. C• Sao `7 T 1—`���� SEPTIC TANK CAPACITY 1_`jTn2_,1c✓�[ 0 LEACHING FACILITY. (type) (size)NO.OF BEDROOMS OWNER PERMIT DATE: d ( l`7 COMPLIANCE DATE: �- 0 Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility —f— Feet Private Water Supply Well and Leaching Facility(If any wells exist on site or within 200 feet of leaching facility) t`( Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) Feet FURNISHED BY ,J i Town of Banstable. P# °F Department of Regulatory Services • 1p1S10II Bate - Public Heath D ,16�M�e� 200 Main street,Hyannis MA 02601 Date Scheduled !Time_ Fee Pd. cl-kozp Suitability Asessentfr Sewa IsPom S a Performed By: ' Witnessed By V° IAJ • - LOCATI ij&G R!AL"INFORM�►TION Location Address Owners Name C O t 6 ice/ L U�I'e I Addre s Assessor's Map/P4rcel: 2'L��( � 3:1 I Engineer's Name NEW CONMRUtON REPAIR { Telephone# .Sdg r3 6 0 33 l( Land Use I I y � ' Slopes(96) ' — Surface Stones ! Distances from: Open Water Body } ? R Possible Wee Area �/1 ft Drinbng Water Well=�ft �- /00 I 1)tainage Way ft Ptoperty Lineft Other ft SKETCH:(street name,dimensiods'of lot,exact locations of le; ,St holes&perc tests,locate wetlands in proximity to holes) Se S S sf�,M Y 121, i /t; �,�0 a t�' l�la ►� s I • i iGl�l OVtt/�a S� Depth to Bedrock • 1 Gt Parent material(geologic I eP Depth to Groundwater. Standing Water in Hole:' ki Weeping from Pit Free A Estimated Seasonal Vgh Groundwater Dt TION FOR SEASONAL HIGH WATER TADLE Method Used: in. Depth C14erved standing;in obs.hole: In. Depth to soil mottles: Depth tolweeping from side of obs.hole: in, O;oundwhter Adjustment ft. index Well# Reading Date: Index Well level Ac�•lfaetor„^, Aru,OtYwndwater Level • I PERCOLATION TEST • Date Thm Observation ` I t 7 Me at 9" ... Hole# Depth of Pere b•t �S Time at 6" Start Pre-soak Time. I() a /0 { ! 'lime(9,W) End Pre-soak w. /Z /U ZZ i Rate M•inAnch Site Suitability Asse0sment: Site Passed_ Site Failed; Additional Telling Needed(Y/IV) Original:.Public Health Division Observation Hole Data;To Be Completed on Back ***If percolali0n test is to be conducted within 100' of wetiand,,you must first notify the Barnstable C4#servation DiNzsion at least one(1)wedlt prior to beginning. DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency. ravel 44Lam � � to R 3/v Z*l 1L4a^V1faMd /O -72 / C' meo �Wb .:Sy 7/ DEEP OBSERVATION HOLE LOG Hole#_ Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consis enc %Gravel) D � • —72'" 13 L0444 TkAk 1 O'Y4"A0 " C `(' 2 S 7/3 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) Q'► , g t► A- Lmik ,%ej toy R:31y Oct J4,�A DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. iste Stind U0 1g Ld r S&AJ C11�(LS/ 7F_ Flood Insurance Rate Mau: Above 500 year flood-boundary No;_ Yes Within 500 year boundary No_X Yes Within 100 year flood boundary No X Yes 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 pe ious material? Certification I certify that on (date)I have passed the soil evaluator examination approved by the nmental Protection and that the above analysis was.performed by me consistent with Department of Enviro the required tra 'ng xpertise nd a erie a described in 3.10 CIv. 15.017. I Signature Date Q:4SEFTICIPERCFORM.DOC I d- �A2 rn►a�' C 2G�3 N o . _ 33 o s LOCATION �-•� 11 DATE V I L LAG E C� C'1�1'f��/ FEE (APPLICANT 3C HI-3 (Non-refundable ; ADDRESS TELEPHONE NO - ENGINEER_Tti-�T� Y3 TELEPHONE NO . o DATE SCHEDULED (Applicant ' s signature . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . • SOIL .LOG DATE - $ TIME 1�. °o Pr-► SUB-DIVISION NAME ENGINEER 'h• EXPANSION AREA: YES--,, NO �py,� J RCO r3J BOARD OF HEALTt' TQWN WATER PRIVATE WELL gA EXCAVATOR SKETCH: (Street name , etc . , dimensions of lot, exact location of test holes and ;' percolation tests , locate wetlands in proximity to test holes ) NOTES : l kph' N � 3 75 / PERCOLATION RATE : ELEVATION: TEST HOLE NO: ELEVATION : TEST HOLE NO: 1 LoH w� 1 c) s�gSo iv 2 SegS 2 e .c. 3 3 4 5 5 ' 6 0ve 0 7 7 8 g 9 9 10 10 11 11 12 12 13 13 n o La Pk,_ 14 r 0 14 15 15 16 16 LD _ FOR SUB-SURFACE SEWAGE : LEACHING FIENCHES EACHING PITS SUITABLE LEACHING THE _X=__ o UNSUITABLE FOR SUBSURFACE SEWAGE . REASONS :- `- G PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION HFA .TH �THE Tp� Town of Barnstable Barnstable Regulatory Services Department ' : 'doac j BARNSCABUF, `"�: ,m� Public Health Division FD""AAA 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7012 1010 0000 2847 8148 November 1, 2016 MCATEER, JOANNE STARKEY TR PO Box 711 CENTERVILLE, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE,TITLE 5 The septic system located at 31 Cedar Point Circle, Centerville,MA was inspected on 10/24/2016 by Michael DiBuono, certified Title V Septic Inspector for the State of Massachusetts. The inspection of the septic system showed that the system"Fails" under the guidelines of 1995 TITLE V (310 CMR 15.00) due to the following: • Leaching pit with staining above invert, septic tank is leaking, and distribution box is rotted. You are ordered to repair or replace the septic system within two (2)years 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 BORD OF HEALTH Thomas McKean, R.S., CHO Agent of the Board of Health QASEPTIC\Letters Septic Inspection Failures or Future Evl\31 Cedar Point Circle Centerville.doc � J Town of Barnstable + SARNSTAHLE, 6 9. ,�� Regulatory Services Department Public Health Division 200 Main Street,Hyannis MA'02601 Office: 508-862-4644 Richard Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO Feb 6, 2007 Rev. 5/11/16 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 ❑ Discharge or ponding of effluent to the surface of the ground ❑ Pumping more than 4 tunes 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, <12"below inlet(per Town Code §360-9.1) ❑ Leaching facility with standing liquid level at or above the invert pipe (per Town Code §360-20 h) OTHER -j W�1� �S'T��✓�%n P' b Ve I'Avef-4 )-eA c,n Se �, d Repair deadline: \Jprlll- � WSEPTIMDEADLINES TO REPAIR FAILE6 SYSTEMS.doc Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments Ca 31 Cedar Point Circle Property Address co George Deyesso _ Owner Owner's Name tTi information is ✓ 3> required for every Centerville _ Ma 02632 10/24/16 page. City/Town State Zip Code Date of Inspection �9 W Illp Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see.completeness checklist at the end of the form. Important:When filling out forms A. General Information on the computer, use only the tab 1. Inspector: key to move your cursor-do not Michael DiBuono use the return Name of Inspector key. DiBuono Sewer and Drain Company Name 8 Johns path Company Address S Yarmouth Ma _ _ 02664 City/Town State Zip Code 508-364-9587 S103522 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address.and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5 (310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evalua th Local Approving Authority 10/24/16 _ Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority (Board of Health or DEP) within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins•3113 - Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 1 of 17 5�gl YS Commonwealth of Massachusetts w Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address =` George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page, CitylTown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B) System Conditionally Passes: ❑ One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND) for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank (whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. * A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 31 Cedar Point Circle _ Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page. CitylTown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s) or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins•3/13 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 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page. CityFrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS) and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance.- This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate "Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than 'h day flow t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 4 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments �nM 31 Cedar Point Circle Property Address George Deyesso _ Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for 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 El ❑ 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•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 5 of 17 I Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments a 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no" as to each of the following: Yes No ❑ ® Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms (design): 3 Number of bedrooms (actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 c Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e 31 Cedar Point Circle Property Address George Deyesso _ Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every — page. City/Town State Zip Code Date of Inspection D. System Information Description: _,h q.p, System contains 100®GI septic tank as well as a concrete distribution box and a 1000 GI leach pit. Septic tank liquid is at mid level and is most likely leaking at seam and or weep hole. Distribution box is rotted and decaying with roots inside. Leach pit is dry and was inspected with large LED light and camera. no stain line was found. Leach pit has staining from floor to up over invert pipe.Staining in out flow pipe was visible all around inside of pipe. System is in failed condition contrary to last inspection report performed September 29 2015. Number of current residents: Vacant Does residence have a garbage grinder? ® Yes ❑ No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ❑ No Water meter readings, if available last 2 ears usage d 239 Gpd 9 ( Y 9 (gP ))� Detail: Sump pump? ❑ Yes ❑ No Last date of occupancy: 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 I Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: -- --- -- -- t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 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: Not provided Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every page. CityfTown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known) and source of information: installed 1985 Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): 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.): System is vented through roof _ Septic Tank (locate on site plan): Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain) 1000 If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: --- Sludge depth: — t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts w Title 5 Official Inspection Form Irl Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle_ Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 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 Tank is leaking at seam and or weep hole 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 How were dimensions determined? Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Evidence of leaking Tees and or baffles in place at time of inspection. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every - - -.— page. CitylTown 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.): Baffles are in place tank appears to be leaking 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•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments e,O 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 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 Rotted , decayed, with roots Comments (note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No" Alarms in working order: ❑ Yes ❑ No" Comments (note condition of pump chamber, condition of pumps and appurtenances, etc.).- If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts U9" Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle _ Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: — --- Comments (note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Staining in pit from top to bottom as well as distribution box and inside out flow pipe. Cesspools (cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration -- Depth -top of liquid to inlet invert - Depth of solids layer --- Depth of scum layer Dimensions of cesspool Materials of construction — Indication of groundwater inflow ❑ Yes ❑ No t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 13 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form - Not for Voluntary Assessments .w 31 Cedar Point Circle Property Address George D_eyesso Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every page. Cityrrown 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.): No ponding no break out 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•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 . Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every -- ------ ------- page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ❑ hand-sketch in the area below ® drawing attached separately t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments °�a,•'` 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is required for every Centerville Ma 02632 10/24/16 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 10+ ft 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: April 1985 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: To be determined at time of perk test. Also on plan on file Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 �orrrmvnwealth Of:Massachusetts , 1 �e ;5 OfflClal Subsurface Sewage Disp6sai'S sj Qn Form- vats peCt-� t11 m F.orm iVo for Volun(ary As�sment*s tt Cedar point CircieCentervdie i Pmpeny 9 �oanneStarkey Mcateer 228 p t Owners Name e' P O;Box 71 t-,Centerville � tVt/ Ste State �p63ode SeptembeL2 Zp 5 Y m information (cont)i 'Sketch of Sewa 1 ge-Otsposal System.Prov de a view of the sewage disposal system inciudrn at least two permanent reference landmarks or where public watersuRpiy=enters the,'-ld-- Check onerdf the boxeslbe aw to �t hard='sketch n the area below ` Q drawing attached separately 77. iy Y 1€ 1 ss c = 33 f f Y Y ro 'p` al!u+ssFa o berm;S� tm�e Sew W, s f Commonwealth of Massachusetts W Title 5 Official Inspection Form Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 31 Cedar Point Circle Property Address George Deyesso Owner Owner's Name information is Centerville Ma 02632 10/24/16 required for every _ _ page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ❑ Inspection Summary: A, B, C, D, or E checked ❑ Inspection Summary D (System Failure Criteria Applicable to All Systems) completed ❑ System Information— Estimated depth to high groundwater ❑ Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts 10 6 Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Y Joanne Starkey Mcateer Owner Owner's Name information is required for every p O. Box 711, Centerville MA 02632 September 29, 2015 page. Cityrrown State Zip Code Date of Inspection m, Inspection results must be submitted on this form. Inspection forms may not be altered in any C.4 way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information C on the computer, ./ use only the tab 1. Inspector: key to move your cursor-do not Troy Williams use the return Name of Inspector key. Troy Williams Septic Inspections Company Name 19 Hummel Drive Company Address South Dennis MA 02660 Citylrown State Zip Code (508) 385- 1300 S1682 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority September 29, 2015 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. �p S t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal s m'Page 1 of 17 I Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is P.O. required for every . OX 711, Centerville MA 02632 September 29, 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A B C D or E/alwaYs complete II 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 meets minimum standards set by Massachusetts DEP at the time of inspection only.This inspection is not a guarantee or warranty on the future working conditions of leaching, pipes, components or the future structural integrity of said components and only represents conditions found at the time of inspection only. B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no" or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND (Explain below): t5ins•3113 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments .�' 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer _ Owner Owner's Name information is required for every P.O. Box 711, Centervillep MA 02632 September 29, 2015 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s) are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND (Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 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 M 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 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 fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ❑ ® Liquid depth in cesspool is less than 6" below invert or available volume is less than %day flow t5ins•3/13 Title 5 Official Inspection Forth:Subsurface Sewage Disposal System•Page 4 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments y 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 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•3/13 Title 5 Official Inspection Forth: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 4M 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is p O. BOX 711 required for eve , Centerville MA 02632 every September 29, 2015 page. Citylrown State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes" or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ ® Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner) provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System (SAS) on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 gpd t5ins-3/13 Title 5 Official Inspection Forth: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 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every p O. Box 711, Centerville MA 02632 September 29, 2015 page. City/Town State Zip Code Date of Inspection D. System Information Description: Number of current residents: 0 ( 1 prior)_ Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system? (Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ® Yes ❑ No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 14=48,000 gals. g ( y g (gp ))' 13=49,000 gals. Detail: Sump pump? ❑ Yes ® No Last date of occupancy: vacant approx. 2 months Commercial/Industrial Flow Conditions: Type of Establishment: N/A Design flow(based on 310 CMR 15.203): N/A Gauons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): N/A 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: N/A t5ins•3113 Tide 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 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is P.O. BOX 711 required for every , Centerville MA 02632 September 29, 2015 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: N/A Date Other(describe below): N/A General Information Pumping Records: Source of information: Last pumped in 2013. Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 8 of 17 I Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer _ Owner Owner's Name information is required for every p O. Box 711, Centerville MA 02632 September 29, 2015 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: Tank, d-box and leaching were installed on 9/16/85 per compliance. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): Depth below grade: 18"+ 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.): Flushed lines and found clear at the time of inspection. Septic Tank(locate on site plan): 161 Depth below grade: 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: 5'X9'X6' 1000 gallon Sludge depth: 4" t5ins•3/13 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 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 page. Cityfrown 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 2'8" Scum thickness thin layer Distance from top of scum to top of outlet tee or baffle 6" Distance from bottom of scum to bottom of outlet tee or baffle 14" How were dimensions determined? probe/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.): Inlet and outlet tees were found present and in working order. No evidence of leakage or damage was found. Tank was not in need of pumping at this time. Grease Trap(locate on site plan): Depth below grade: N/A feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Scum thickness N/A Distance from top of scum to top of outlet tee or baffle N/A Distance from bottom of scum to bottom of outlet tee or baffle N/A Date of last pumping: N/A Date t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 i Commonwealth of Massachusetts Ix Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M -228 P- 113 _ Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 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: N/A Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: N/A Capacity: N/A gallons Design Flow: N/A gallons per day Alarm present: ❑ Yes ❑ No Alarm level: N/A Alarm in working order: ❑ Yes ❑ No Date of last pumping: N/A Date Comments(condition of alarm and float switches, etc.): N/A *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is p O B required for every P.O. 711, Centerville MA 02632 September 29, 2015 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 level 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 was found level and in working order. 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.): N/A *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located, explain why: t5ins•31113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 'y( 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is p O. Box 711, Centerville MA 02632 September 29, 2015 required for every P page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 -6'X6' pit with1'of stone ❑ 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.): Leach pit was dry on inspection with a visible stain line approx. 18" below inlet invert. No evidence of hydraulic failure or problems in the past were found at the time of inspection. Cesspools,(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration N/A _ Depth—top of liquid to inlet invert N/A Depth of solids layer N/A Depth of scum layer N/A Dimensions of cesspool N/A Materials of construction N/A Indication of groundwater inflow ❑ Yes ❑ No t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments `l 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is p O B required for every P.O. 711, Centerville MA 02632 September 29, 2015 page. Cityrrown 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.): N/A Privy(locate on site plan): Materials of construction: N/A Dimensions N/A Depth of solids N/A Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): N/A t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 14 of 17 Commonwealth of Massachusetts _ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 page. CitylTown 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 O O V 3 ' - t5ins•3/13 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 °M 31 Cedar Point Circle, Centerville M -228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 13.0'+ 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: MIW 29 Zone C 9.1' 4.5'adjustment You must describe how you established the high ground water elevation: Test hole recorded on plan showed no water found at 12.0'. Hand augered 4.5' below bottom of leaching with no water found at a depth of 15.5'. Groundwater adjustment at the time of inspection was 4.5'. Bottom of leaching at 11.0'was found not to be located in the high groundwater elevation at the time of inspection. USGS groundwater map shows groundwater at approx. 19.2'. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 31 Cedar Point Circle, Centerville M-228 P- 113 Property Address Joanne Starkey Mcateer Owner Owner's Name information is required for every P.O. Box 711, Centerville MA 02632 September 29, 2015 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary: A, B, C, D, or E checked ® Inspection Summary D (System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 17 of 17 �f Ivir Page 1 of 2 McKean, Thomas From: McKean, Thomas Sent: Wednesday, March 05, 2003 8:52 AM To: 'jmcateer' Subject: RE: 31 Cedar Point Circle,Centerville Thank you for your letter Ms. McAteer. All of the Health Division personnel were notified of the two conflicting inspection reports submitted to us from private DEP certified inspectors hired by the homeowner in regards to your property. It is an unfortunate situation. Also your letter dated March 4, 2003 will be kept on file for future reference in this regard. -----Original Message----- From:jmcateer [mailto:jsmcateer@attbi.com] Sent: Tuesday, March 04, 2003 3:00 PM To: McKean, Thomas Subject: Re: 31 Cedar Point Circle,Centerville -----Original Message----- From:jmcateer To: thomas.mckeanCcD-town.barnstble.ma.us Sent: Wednesday, January 29, 2003 8:05 AM Subject: 31 Cedar Point Circle,CenterviIle Thomas A McKean, CHO RE: Your e-mail of January 6,2003 SENT TO: Joanne McAteer jsmcateer@attbi.com Mr. McKean, I have complied with your request of 1/6/03. On 1/10/03, I met at my home (31 Cedar Point Circle, Centerville) with David Stanton, another man from your department to whom I was not introduced, and Roger Roberts, Mass State inspector. They all agreed there was not a problem with the leaching pit and therefore no problem with my septic system. I asked David Stanton for a letter stating the results of the inspection so this situation would not happen again. I have spent approx. $500 to have the pit located, dirt removed from a 10' excavation in the back garden and attorney expenses. (Remember the septic system was approved prior to my purchase in February 1999—if it had not been,the sale of the home would not have closed.) Last week my builder went to your department in Barnstable to get a sign off in order to start my remodeling job. There was confusion, time spent, and finally a hand written, "passed", a date, and initials I could not read. This was the only `sign-off given. I do not want this confusion to continue. When the time comes to sell my home, I want this erroneous 1996 septic report corrected. I want a letter or report that the leaching pit inspection on 1/10/03 was done and passed. This letter or report to be placed on file at your Health 3/5/2003 Nr Page 2 of 2 Department and also for my personal file at home. I would appreciate your immediate attention. Thank you. Joanne McAteer 508/790-9383 1.Copy to: Mary LeClaire, Barnstable County Commissioner 3/5/2003 i Stanton, David From: McKean, Thomas E COPY ATTEST Sent: Monday, January 06, 2003 3:46 PM To: 'jsmcateer@attbi.com' Cc: Stanton, David • Subject: Septic System Inspections/31 Cedar Point Circle Public Health Division BARNSTABLE Dear Ms. McAteer, Thank you for coming into the Public Health Division Office this morning. I am writing because you requested a written letter from me detailing what course of action should be taken at this time. As you recall, two(2) septic system inspections were conducted on the same septic system at your property located at 31 Cedar Point Circle. The first inspection, conducted by Robert Bortolotti on November 4, 1996, indicated that the system had "failed" and a new leaching pit was needed. The report also indicated the existing leach pit had 58 inches of wastewater in it. An order letter was mailed to the previous homeowners, John and Lenice Maher on April 3, 1998 directing them to repair the septic system. However, the Public Health Division did not receive any response to that order letter. It should be noted here that a permit is required for any septic system repair work conducted to a septic system. The second inspection, conducted by Rodger Roberts on December 12, 1998, indicated that the system had "passed" and the leaching pit was in a"good, dry, condition." That report also indicated that the system was pumped on the same day of the inspection. According to our records, there wasn't any repair work done to the subject septic system as of this date. A letter was then mailed to you the new homeowner on August 10, 2002 reiterating the failed nature of the septic system and the need to repair it. Again, the Public Health Division did not receive any response during the ensuing months following that letter. Then last week, while attempting to obtain a building permit for an addition, you were again informed the septic system needed to be repaired. You then informed us that it was your understanding that the system had "passed"an inspection. Due to the conflicting inspection results information received, it is my recommendation that the leaching pit component should be re-inspected with a witness present from the Public Health Division staff to determine whether or not the leaching pit component in fact"passes" or"fails" the inspection criteria of the Massachusetts Department of Environmental Protection. Please contact a DEP certified septic system inspector to arrange an inspection of the leaching pit component (not of the entire septic system). When a date/time is scheduled for the component inspection, please contact Health Inspector David Stanton, RS, of this Office so that he may witness the inspection. Mr. Stanton can be reached at 508 862- 4644. Sincerely yours, Thomas A. McKean, CHO U1) 4ed 5,� wf tad 20,�cl � S' ' 6 -°lU1"p-�y �JAA, } rywac � yltl ec� And ok,d Al-f /?()� -YV S�f�ewt Inr,�� Q 145 in 41'-e J��'Qj Y�u�C{iGf 14 j a� k!me V� rn I ��o^ FIB► I I was , V e we GY A� � 4, ln r 61�tQr,�. /l�i wtiJ �i D °r "n /_/�wa,,'h, P � i 1, i it + 1 - wr1 a' ,.� as • .. � . • • ke ,JJ �4 v. `7 - i - } - ., w ,y "Will s`, �. w .. Thomas A McKean,CHO RE: Your e-mail of January 6,2003 SENT TO: Joanne McAteer jsmcateer@@ttbi.com Mr. McKean, I have complied with your request of 1/6/03. On 1/10/03, I met at my home(31 Cedar Point Circle,Centerville)with David Stanton,another man from your department to whom I was not introduced,and Roger Roberts,Mass State inspector. They all agreed there was not a problem with the leaching pit and therefore no problem with my septic system. I asked David Stanton for a letter stating the results of the inspection so this situation would not happen again. I have spent approx. $500 to have the pit located, dirt removed from a 10' excavation in the back garden and attorney expenses. (Remember the septic system was approved prior to my purchase in February 1999—if it had not been,the sale of the home would not have closed.) Last week my builder went to your department in Barnstable to get a sign off in order to start my remodeling job. There was confusion,time spent, and finally a hand written, "passed",a date,and initials I could not read. This was the only`sign-off given. I do not want this confusion to continue. When the time comes to sell my home,I want this erroneous 1996 septic report corrected. I want a letter or report that the leaching pit inspection on 1/10/03 was done and passed. This letter or report to be placed on file at your Health Department and also for my personal file at home. I would appreciate your immediate attention. Thank you. Joanne McAteer 508/790-9383 • Copy to: Mary LeClaire,Barnstable County Commissioner BORTOLorn CONSTRUCTION, INC. / NO 765 WAKEBY ROAD, MARSTONS MILLS, MA 02648 _ k 508-771-9399 508-428-8926 FAX: 508-428-9399 - s, } n _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM-' - PART A CERTIFICATION Property Address:2z Oe i o/- C2 ' �/ /Il Date of Inspection: /,�- V—9C� Inspector's Nanic: A 4 O er's Name and Address: CERTIFICATION STATEMENT: I certify that I have personally inspected the sewage disposal system at this address and that the ittforma- tion reported below is true, accurate and complete as of the time of inspection. The inspection was per- formed based on my training and experience in.the proper function and maintenance of on-site sewage disposal systems. The System: 6 S S p Passes Conditionally Passes` U 110 Needs Further Ev ation By ie cal Aproving Authority Fails Inspector's Signature: __ Date:_A� The System Inspector shall submit a py of this inspection report to the Approving authority within thir- ty(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 Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable and the approving au(hority. INSPECTION SUMMARY* A)SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CM.R 15.303. Any f failure criteria not evaluated are indicated below. B)SYST M CONDITIONALLY PASSES; V One or more system components need to be replaced or rcpaire The system, up comple- tion of the replacement or repair, passes inspection. ,r/) S o t y ew / /7lj j Indicate yes, nor,or not determined(Y,N,OR ND). Describe basis of determination in all instances. if "not determined",explain why not. The septic tank is metal, cracked, structurally unsound, shows substantial infiltration or exfiltration,or tank failure is imminent. The system will pass inspection if the existing sep- tic tank is replaced with a conforming septic tank as approved by The Board of Health. Sewage backkup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipc(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of The Board of Health): - 1 - L _ SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Broken pipe(s)replaced Obstruction is removed Distribution Box is levelled or replaced The System required pumping more than four 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. 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 the public health,safety and the environment. 1)SYSTEM WILL PASS UNLESS BOARD OF IIEALTJI DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER WHICII WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: Cesspool or privy is within 50 Feet of a surface water Cesspool or privy is within 50 Fcct of a bordering vegetated wetland or a salt marsh. 2)SYSTEM WILL FAIL UNLESS TILE BOARD OF IIEALTII (AND PUBLIC WATER SUPPLIER,IF APPROPRIATE)DETERMINES THAT THE SYSTEM IS FUNCTION- ING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: The system has a septic tank and soil absorption system and is within 100 Feet to a surface water supply or tributary to a surface water supply. The system has a septic tank and soil absorption system and is with a Zone I of a public water supply well. The system has a septic tank and soil absorption system and is within 50 Feet of a private water supply well. The system has a septic tank and soil absorption systent and is less than 100 Feet but 50 Feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from the facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. D)SYSTEM FAILS: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identilied below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of eIluent 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 clog- ged SAS or cesspool. Liquid depth in cesspool is less titan G"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year N_�duc to clogged or obstructed pipe(s). Number of times pumped -2- I' SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. Any portion of a 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 I 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. If the well has been analyzed ` to be acceptable,attach copy of well water analysis for coliforn►bacteria,volatile organic compounds,ammonia nitrogen and nitrate nitrogen. E)LARGE SYSTEM FAILS: The following criteria apply to a large system in addition to the criteria above: The design flow of a system is 10,000 gpd or greater(Large System)and the system is a significant threat to public health and safety and the environment.because one or more of the following conditions exist: 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'n►apped Zone 11 of a public water supply well. The owner or operator of any such system shall bring the syste►u and facility into full compliance with the groundwater treatment program requirements of 314 CM 5.00 and 6.00. Please consult the local regional office of the Department for further information. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART It CI I ECKLIST Check if the following have been done: _Pumping information was requested of the owner,occupant, and Board of Health. L—None of the system components have been pumped for atleast two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or as part of this inspection. _L,L'As-built plans have been obtained and examined. Note if they are not available with N/A. _ The facility or dwelling was inspected for signs of sewage back-up. riThe system does not receive non-sanitary or industrial waste flow. r/The site was inspected for signs of breakout. All system components,excluding the Soil Absorption System, have been located on site. of The septic tank manholes were uncovered,opened, and the interior of the septic tank was in- spected for condition of bafles or tees, material of construction, dimensions,depth of liquid, /depth of sludge,depth of scum. ✓ The size and location of the Soil Absorption System on the site has been determined based on existing information or approximated by non-intrusive methods. -3- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART 11 CHECKLIST(continued) VT'he facility owner(and occupants, if different from owner)were provided with information on the proper maintenance of Subsurface Disposal System SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION` FLOW CONDITIONS RESLDENTLAL: Design Flow: gallons Number of Bedrooms: Number of Current.Residents: 7 Garbage Grinder: Laundry Connected To Systcm: e—S Seasonal Use: O Water Meter Readings,if a}c$ilable: Last Date of Occupancy:�rj/Yez2 - C0MMERC LAWN D O Type of Establishment: Design Flow: gallons/day Grease Trap Present: (yes or no) Industrial Waste Holding Tank Present: __ Non-Sanitary Waste Discharged To'fhc Title v System: Water Meter Readings,If Available: _ Last Date of Occupancy: OTHER: Describe) Last Date of Occupancy: _ GENERAL INFORMATION �/pd )E'C� /- t� � lleuerDPP '/�n urcc of informa n:PUMPING RECORDS a d so � �° _ �._� f1�s' System Pumped as art of inspection:NU If es,volume pumped: gallons Y P P P Y Reason for pumping: TYPE O STEM: eptic Tank/Distribution Box/Soil Absorption System Single Cesspool r Overflow Cesspool Privy Shared System(If yes, attach previous inspection records, if any) Other(explain): ""OXIMATE AGE of all co nponent ,date installed (if known)and source of information: Sewage odors detected when arriving at the site: -4- i SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C GENERAL INFORMATION (continued) SEPTIC TANK: Depth below grader Material of Construction: t/ncretc metal . FRP Other (explain) Dimisions:g,S'X[p'X.S Sludge Depth: Scum T'hickness:_/j Distance from top of sludge to bottom of outlet tee or balfle: Distance from bottom of scum to bottom of outlet tee or baffle: Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation outlet invert, structural integrity, evidence of leaka e,etc.) =7`��S' IQ c Q 91F(_"fc'A 60 a c b41 m /10&-'�n8 GREASE TRAP:_ Depth Below Grade: Material of Construction: concrete metal FRP Other (explain) — —_ — — Dimensions: Scum Thickness Distance from top of scum to top of outlet tee or ba.tTlc: F. Comments: (recommendation for pumping,condition of inlet and outlet tees or baffles,depth of liquid level in relation to outlet invert, structural integrity, evidence of leakage, etc.) TIGHT OR HOLDING TANK:/Y U Depth Below Grade: Material of Construction:—concrcle—ntctal__FRP—Other(explain) Dimensions: Capacity: gallons Design Flow: gallons/day . Alarm Level: Comments: (condition of inlet tee,condition of alarm and float switches, etc.) DISTRIBUTION BOX: Depth of liquid level above outlet invert: O/'Cl%?,C �Pap/ Comments: (note iWewel and distribt toil is a ual,evil tce of soli s carryover, evidenc of leak ge in or out of box, c. i�(_(`, rij Cg PUMP CHAMBER: Pump is in working order: Comments: (note condition of pump chamber,condition of pumps and appurtenances,etc.) -5- SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) SOIL ABSORPTION SYSTEM (SAS):_ (Locate on site plan, if possible;excavation not required,but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: Leaching pits, number:Leaching chambers, number: Leaching galleries,number. Leaching trenches, number, length: Leaching fields, number,dimensions: _ Overflow cesspool, number: Comments: (note condition of so' , signs of hydraulic failure level of ponding, conditi it of ve a tion, " dr- % a r g CESSPOOLS: Number and configuration: Depth-lop of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of Cesspool: Materials of construction: Indication of groundwater: Inflow(cesspool must be pumped as part of inspection) Comments: (note condition of soilk, signs of hydraulic failure, level of ponding,condition of vegetation, etc.) —---- PRIVY: Materials of construction: Dimensions: Depth of Solids: Comments: (note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation, etc.) - -G - 1 '. SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTF,M INFORMATION (continued) c� Z5- SKETCH OF SEWAGE DISPOSAL SYSTEM: Include ties to atleast two permanent references, landmarks or benchmarks Locate all wells within 100 Feet. O �crtce G,v /S6 DEPTH TO GROUNDWATER: Depth to groundwater: 1 y Feet Method of Determingtiono5 Approximation:_—L4YU�i'� l*rlar e� o ice/ sr�y � -7- I ''HM ] H E A L T H M A S T E R ] HELP [ ] R E C O R D ] ACTION I] For Parcel Number 2281 1131 0041 ] Rental Property(Y/N) [ ] Owner Name MAHER, JOHN W & LENICE G ] Zone of Contrib (Y/N) [ ] Location 31 CEDAR POINT CIRCLE ] Contaminant Rel (Y/N) [ ] Business Name [ ] Area Number Contact Person [ ] Phone [000] [ ] Fuel Storage Tank Permit [ ] Card on File [ ] Perc Test Well Septic File/Permit No. [ ] [ ] [85- 4841 Issuance Date [ ] [0913851 Completion Date [ ] [0916851 Last Communications [ ] (MMDDYY) Comments [TITLE V ] Cancel [ ] NEXT SCREEN [HM ] ACTION [ ] PARCEL NBR [ ] [ ] [ ] TANK NBR [ ] ] [ ] Health Complaints 03-Feb-03 Time: 9:00:00 AM Date: 1/10/2003 Complaint Number: 3911 Referred To: DAVID STANTON Taken By: DAVID STANTON Complaint Type: TITLE V SEWAGE Article X Detail: Business Name: Number: 31 Street: CEDAR POINT Village: CENTERVILLE Assessors Map-Parcel: 228-113-004 Complaint Description: Wants to get a building permit approved, yet we have a problem with our records showing a failed, and a passed septic system inspection report. Actions Taken/Results: DS AND SW VISITED SAID LOCATION WITH RODGER ROBERTS, WHOM PASSED THE SEPTIC SYSTEM AFTER BORTOLOTTI FILED A FAILED INSPECTION REPORT. IT WAS IN A PASSING STATE AT TIME OF INSPECTION (ONLY LEACH PIT WAS INSPECTED, AS THAT IS WHAT WAS CLAIMED TO HAVE BEEN IN FAILURE) A BUILDING PERMIT MAY BE PULLED, AS ACCORDING TO THE BOARD OF HEALTH RECORDS FOR THE SEPTIC SHOW IT IS IN A PASSING STATUS. PHOTOS ARE IN THE RESIDENTIAL FILE. Investigation Date: 1/10/2003 Investigation Time: 11:00:00 AM 1 v TOWN OF BARNSTABLE O SEWAGE # "VILLAGE 0;LY ASSES R'S MAP LOT 1 3 00 J/YSPC0�4, _:NAME&PHONE No. �1` 7'• P SEPTIC TANK CAPACITY/000 < o �� �. 00X LEACHING FACILITY: (type) (size) /060 NO.OF BEDR 13 BUILDER �0— WNER C �'1l� PERMTTDATE: COMPLIANCE DATE: D 3 Separation Distance Between the: Maximum Adjusted Groundwater Table and Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching facility) /S-O Feet Furnished by � s q 9 lo'f Postal Service CERTIFIED MAIL RECEIPT •. Only; a F F I C I A L p Postage $ Er 9G 1> Ln Certified Fee 'y Cf Postm k Return Receipt Fee 7 LP Here}� Pt1 (Endorsement Required) 0 Restricted Delivery Fee C3 (Endorsement Required) O Total Postage&Fees $ 4 . 9' It _ a Sent To Joanne Starkey o Mcateer TR Street,Apt.No., � 31 Cedar Point Circle o _ p 6 ty State,zrP Centerville, MA 02632 Certified Mail Provides: o A mailing receipt. o A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail. o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. e For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o 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,May 2000(Reverse) 102595-99-M-20U Town of Barnstable GF THE 1p� do Regulatory Services saMsrasze Thomas F. Geiler,Director 16.9. � Public Health Division rEDMA'�p Thomas McKean, Director 200 Main Street, Hyannis,MA 02601 Office: 508-862-4644 Fax: 508-790-6304 Joane Starkey Mcateer TR Date: 8/10/02 31 Cedar Point Circle Centerville, MA 02632 FINAL NOTICE ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. Our records indicate the septic system owned by you located at 31 Cedar Point Circle Centerville, Ma 02632 was inspected on 11/4/96,by Robert Bortolotti a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: Leaching pit needed to be replaced. According to Title V, the owner had two (2) years to repair or replace the system. More than two years has past since the date of this inspection. You were previously notified of the failed septic system. However, the system has not been repaired as required as of this date. Therefore, you are directed to hire a licensed professional engineer (PE) or Register Sanitarian (RC) to design a system that will bring the septic system in compliance with 310 CMR 15.00, The State Environmental Code,Title 5 within twenty-one (21)days of your receipt of this letter. You are also directed to hire a licensed septic system installer to install the system components within forty-five (45)days of your receipt of this order. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings,onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. Failure to comply to this order of the Board of Health, may result in court action against you the owner of this property PER ORDER OF THE BOARD OF HEALTH Thomas A. McKean, R.S., C.H.O. Agent of the Board of Health Town of Barnstable Town of Barnstable Assessors Division Page 1 of 3 IML w — 1DA a ' � �. x M IK. 1 y y4* l e Your Location : Home : Town Departments : Administrative Services :Assessors Division : Property Results <<Back-Forward>> Thursday, May 30,2002 Assessors Division- Property Results Data is based on Fiscal Year 2002 Assessor's Fiscal Year 2002 Assessed Values database and is provided for information Tax Information purposes only. Sales History Land and Building Description Construction Details «Search Again Out Buildings & Extra Features Building Sketch 31 CEDAR POINT CIRCLE Map/Parcel /Parcel Extension: Mailing Address: 228/113/004 MCATEER, JOANNE STARKEY TR Owner of Record: MCATEER, JOANNE STARKEY TR 31 CEDAR POINT CIR Property Location: CENTERVILLE, MA 02632 31 CEDAR POINT CIRCLE Parcel ID:228113004 F Map.I 64 Fiscal Year 2002 Assessed Values ^To —P Appraised Value Assessed Value Building Value: $ 189,800 $ 189,800 Extra Features: $35,700 $35,700 Outbuildings: $400 $400 Land Value: $ 113,500 $ 113,500 Totals: $ 339,400 $ 339,400 Tax Information ^Top Town Tax $3,142.84 Tax Rates(per$1,000 of valuation) C.O.M.M. FD Tax $468.37 Town 9.26 Fire District Rates Land Bank Tax $94.29 Barnstable 2.61 C.O.M.M 1.38 Cotuit 1.69 Total: $ 3,705.50 Hyannis 2.54 W. Barn. 1.54 http://www.town.bamstable.ma.us/ComeOnIn/Departm.../resultsk02.asp?MAPPAR=22811300 5/30/02 r Town of Barnstable Assessors Division Page 2 of 3 -Total does not include special assessments- utner rates Land Bank 3% of Town Tax Due to rounding differences these values are approximate. Sales History ^Top Owner: Sale Date: Book/Page: Sale Price: MAHER, JOHN W & LENICE G 6/15/1984 C96823 $50,000 SILVIA, &SILVIA ASSOCS 2/15/1983 C91889 $0 MCATEER, JOANNE STARKEY TR 2/26/1999 C152142 $365,000 Land and Building Description.^Top Land Building Lot Size(Acres): 1.2 Year Built: 1985 Appraised Value:$ 113,500 Living Area: 1576 Assessed Value: $ 113,500 Replacement Cost: $ 186,098 Depreciation: 8 Building Value: $ 189,800 Construction Details.^Top Style: Ranch Interior Walls: Drywall Model: Residential Interior Floors: CarpetPine/Soft Wood Grade: Custom Grade Heat Fuel: Oil Stories: 1 Story Heat Type: Hot Water Exterior Walls Wood ShingleClapboard AC Type: Central Roof Structure: Gable/Hip Bedrooms: 3 Bedrooms Roof Cover: Wood Shingle Bathrooms: 2 1/2 Bathrms Total Rooms: 7 Rooms Outbuildings&Extra Features ^Top Code Description Units/SQ FT Appraised Value Assessed Value, SHED Shed 60 $400 $400 FPL1 Fireplace 1 $2,800 $2,800 BLA2 Bsmt Liv-Exc 904 $32,200 $32,200 FPO Ext FP Opening 1 $700 $700 Building Sketch ^Top d � I ar< http://www.town.bamstable.ma.us/ComeOnhi/Departm.../resultsk02.asp?MAPPAR=22811300 5/30/02 L Town of Barnstable Assessors Division Page 3 of 3 Ma`p' Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area (Unfinished) BMT Basement Area (Unfinished) FTS Third Story Living Area (Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area (Unfinished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story(Uni FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfi FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) Back -Forward E= Home Departments I Town Information I Contact Town Hall Website Developed and Maintained internally by the Town of Barnstable Information Systems Department Town Hall-367 Main Street- Hyannis,MA-02601-508-862-4000 DISCLAIMER: Although we strive to provide accurate information,we are only human. Please consult directly with the appropriate department if there is a question of accuracy. Copyright 20010 Town of Barnstable. All Rights Reserved. http://www.town.bamstable.ma.us/ComeOnhi/Departm.../resultsk02.asp?MAPPAR=22811300 5/30/02 i ' Septic Inspection Information Data Entry D 1 —2/6/gg Septic I Sn pe t Nor Assessors ma 1228 1113004 lot: Business: Numbers 31 . Address Cedar Point Circle e village.I Centerville Inspec�to Robert Bortolotti Inspect date•. 11/4/96 System Stat s IF Comment: Needs new leach pit. Was CP and changed to Failed 4/14/98 Permit#: Q Repair Date Notification 04-W.- 4/14/98 Engtlnsta ler Installer Repair Deadline.. t 6/14/98 ro C0Mm0NWFALTH OF MASSACHUSEM E)dcuTivEOFmcEoiFENvMONMENTALAI-7AIR9 RECE]1VED1 DEPARTMENT OF ENVIRONMENTAL PRO'TE ON ONE WINTER STREET,80SION, MA 02102 6I 7.292"5500 AUG h 4kitT@�'��d wf-BAI vnuuM F.,%w S CVvCMQr ARGEQ PAUL CE.LUCCI DAVID D.STRUMS Lt,Ooveneor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commifniona PART A /�� COM19CATION Property Addre�1 t�Lp1OW�G"�nj &4 -C- �Adare�of Owner. t1 Date of Inspections of different) Nance of inspector I am a DEP app system jnSpctmr pursuant to Section 134"of Tide E 010 CMR 1SMO) Company Name: f�f Mailing Address: Telephone Nurr*tr: COMFICATION STATEMENT I Certify dhat I have personally inspected the sewage disposal system at ribs address and that the information repotted below it true,accurate and complete as of the time of inspection. the inspection was performed based an my training and experience in the proper function and maintenance of an-site se disposal rtgems. The symm: _✓ Pasieo _ Conditionally Passes _ Needs Further Evaluation By the Local Approving Authority _ Fails inspector's Signature: Date: The System Inspector shall submit a Copy of this inspection report to the Approving Authority within thirty(30)days of Completing this inspection. if the system is a shared system or has a design+ flow of 10.000 go or Met,the inspeanr and the system owner shall submit the report to the appropriate,regional office of the Departrrient of Environmental Protection. The original should be sent to the system owner and copies sent to the buyer, if applicable,able, and the approving authority. INSPECTION SUMMARY: Check /l, 8, C, op D: A) SY M PAS5E5: I have not found any information which indicates that the system violates any of the failure criteria aA defined in 3140 CMR 1$303. Any failure criteria not evaluated are indicated below. COMMENTS: BI SY511M CONDITIONALLY PASSES] „ One or more system components as described In the'Conditional Pais"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. Indicate yes, no. or not determined (Y, N, or NO). Describe basis of determination is all instanhm. if"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate at Compliance fattached! indicating that the tank was installed within twenty(20)years prior to the date of the inspection;or the septic tank,whether or not metal, is cracked, struhawally unsound, shows subantiai infiltration or sxflltration,or tank failure is imminent. The system will pass ingmiction if the existing septic tank is replaced with a conforming septic tank as approvW by die Boars of Health. t:'wtood tM/30/!7► !art i at le DEP an the V4WW Wdo wW hWJAvwbJrognet,ith*—.usreep J% G�nhM M R eE tan0ar UtL-f73-193 - — P.13/13 SUBSURFACE SIEWACE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Addr Owner Date of Inspection: Depth to Croundwater;2 Peet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record Observation of Site(Abutting property, observation hate, basement surnp etc.) Determine it from [=I conditions Oneck with foal Board of health Check FEMA Maps• Check pumping records /Check local excavators, installers Use USCS Data Describe in your own words how you established the High Groundwater Elevation. ft&be completed) 5,1'�k ;�n Se TOTAL P.13 �t - P. 2i13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C 1 y� SYS IM.INFORMATION (eendnued) Property Add fess• f1 1 I� (�il�[ Date of Impecdon: SKETCH OF SEWAGE DISPOSAL SYSTEM-, include ties to at least two pemnanCM Mferenses landmarks Or benchmarks Iopte all.w4ils wkhin 100' (Locate where public water supply comes into house) (rwited 04I33197) Page I of 3.0 KINLIN—GROVER PROPERTIES — P.11i13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPICnON FORM PAST C . SSy$TEM INFORMATION (continued) Property Address:-< Udwx l lok tr,4- OA - Ct 4L VU Owner: M A-kL K- Date of inspection: f 1' Z` SOIL AlSORPTION SYSTEM(SAS):_ (locate on site plan, if possible, excavation not requimd, but may be,appruirnated by non-intrusive methods) If not determined to be present, eiqlain: Type: leaching pits, number.L leaching charribere, number:— leaching galleries, number:_ leaching tranches, number,length:_� leaching fields,number, dimensions: overflow csmpool, number. Alternative system: Name of Technology: Comments: (note condition of soil,signs of hydraulic failure, level f P nding, con¢it+�o ation,etc.) CESSPOOLS: dove on site plan) Number and configuration: Depth-cop of liquid to inlet invert: Depth of solids layer: Depth of scum layer, Dimensions of cesspool: Materials of construction: --- Indication of groundwater: inflow)cesspool 'Must be pumped as part of Inspection) Cornmrits: (note condition of soil,signs of hydraulic failure, level of pondin& condition of vegetation, etc.) PRIVY: (locate on site plan) Materials of construction: _ Dimensions: Depth of solids: Comments: (note condition of soil,signs of hydraulic failurt, l4vol of ponding, mnditlon of vegetation,etc,) (24fts" 04125197) page 1 as 19 PROPERTIES P.10/13 sUesURFACE SEWACI DISPOSAL SYSTEM tNSPECnON FORM PART C SYSTEM INFORMATION (cOntieued) Property Ad rezz 1� CqU-r Owner Date of Irnpectianc E2'Z- t� TIGHT OR MOLDING TANK:�kj(Tank must be pumped Pride to,or at time,Of Inspection) (locate on site plan) Depth below grader Material of construction: _concrete __jyvW Fiberglass_Polyethylene_Othet(exp(2111) Dimensions: Capacity: gallons Design flow:_+,,,,�gallorWday Alarm level:_Alarm-in working order_Yes, _No Date of previous pumping: Comments. (condition of inlet tee,condition of alarm and float switches,etc) 01$TRIBUTION BOX. (locate on site plan) Depth of liquid Iml above outlet Invert: Comments: (note if level and distribution is equal,evidence of solids carryover, evidence of leakage into or out of box,etc) PUMP CHAMBER: (locate on site plan Pumps in working order. (Yes or Nol Alarms in working order(Yes or No) Comments: (note cotdition of pump chamber, condition of pumps and appurtenancol, etv-) (rwi��l b4/S5/991 V&P 7 of 30 llt4-l03-1y . 5tjasultFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continu ed ) Property droos:.J 1 l.C�.B[il PPS,+Ale C/fL, ►�� ��11 [r(.r(� owner. a.ht..•t� Date of Inspection: BUILDING SEWER: (Lomte on site plan) Depth below grade., Material of constructcast iron✓40 PVC other(explain) Distance from�rivate water supply well or suaion line Diameter � Comments: (condition of joints,venting,evldenc le , It SEPTIC TANK:Y (locate on site plan) tit Depth below grader Material of construction: V concre'.e—meta! ,,.Fiberglass _Polyethylere_atharfexp{ain? if tank is metal, list age! Is age confirmed by Certtficate of Compliance�( eslNo) Dimensions- Sludge depth f r Distance from top of sludge to bottom of outlet tee or baftle: Saint thickness:_ l Distance from top of sctmt m top of outlet tee or baffle: �� It) Distance from bottom of scum to bottom of tlet at baffler Now dimensions were determined: Comments: (recommendation for pumping, condition of Inlet and outlet tees or baffles, depth Of liquid level in relation to cutlet invert, structural integrity,evidence of leakage, eml GREASE TRAP:: goate on sits plan) DWh below grade:_ Material of construction: ;_,concrete_Metal _Fiberglass Polyeftlene piher(expia{n) Dimensions: Scum thickness: Distaince from top of scum to top of outlet toe ar baffle: Distance from bottom of scum to bottom of outlet tee or baffle:_ Date of last pumping: Commends: (recommendation for pumping, condition of inlet and outlet tees or baffles,depth of liquid level in,relation to outlet invert.ltructumf integrity,aviden ce of leakage,etc.) f=n'i�ed Q{/ZS/97t P� 6 0� iQ I • .08/13 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION r Property A :�! Q40A, Owner. Date of Irapeetion: FLOW CONDITIONS &ESl T Design flow: 0 gdJbWroorn for S.A.J. Number of bedrooms: .5 Number of current residents: k:* Garbage grinder(yes or nol:-9 Laundry connected to system or nol: Seasonal use(yes or na1: r Water meter readings, if avallable (last two(2)yew.usage(gpd): Sump Pump h'eS or noh,L Last date of occupancy:—t)jDtSep COMMERCIAL/INDUSTRIAU Type of eabllwnent: Design flow_gailon$lday Grease trap pnsent: (yes or no)— Industrial Waft Holding Tank present (yes or no)_ Nor sanbry waste discharged to the Title 5 sygem: Eyes or na)_ Watter meter readings, if available: Last date of oc Uwcy:— OTHER:(Describe) $oast doe of occupancy-._ GENERAL INFORMATION PUMPING RECORDS and•saurce of info M, System pumped as part of inspecdon: (yes or no)4 If yes,volume pumped; Ions Reason for pumping; G;`� I e K � TYPE O STEM Septic tank/distribution box/sail absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) w VA Technology etc Copy of up to date contract? Other APPROXIMATE AGE of all components, dare installed (if known)and source of infbmtstion: � ' *g, — Sewage odor$detected when arriving at the site:(yes or nofo trnri,«t Oa/Zt/$9S page 3 of it Ltl.,-w-it"d 11 PRUFERTIES P.06i13 SUBSURFACI SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART'A CE�IR".TIFICATION (continued) Propwty Address:s/ t-�0 •�1"P1"f 71.t+ I'r c.( �•t!I tsL.$.. Owner. j , r Gate of IMpetti on� DI SYSTEM FAILS: You past indicate ei;r,er"Yes" or°No"as to each of the following: I have determined that the system violates one or more of the fallowing failure criteria as defined 1m 310 t MK 15.303. The basis for this determination is Identified below. 1,he Board of Health should be contacted to determine what will be necessary to correct the failure, Yes Backup of sewage into facility or system component due to an overloaded or cloned SAS 0r eesspoal. Discharge or ponding of effluent to the s<trkm of the ground or surface wafers due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the distribution box above outlet Invert due to ari overloaded or cloned$AS or cesrpooi. Liquid depth in cesspool is less than 6'below Invert or available volume is less than 112 day flow. _ J _ Required pumping more than 4 times in the last year h=plot to clogged at obstructed pipe(s). • Number of times pumped._ Any portion of the Soit Absorption System,Ce1513001 Or privy is below the high groundwater elevation. Any portion of a cesspool or privy is within 100 fast of a surface water supply or tributary to a surface water supply- Any portion of a cesspool or privy is within a Zone I of a publlC 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 It less than 100 feet but greater than 50 feet from a prlwraa water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliform bacteria,volatile organic compounds. ammonia nitrogen and nitrate nitrogen. 11 LARGE SYSTEM FAILS: You must indicate either"Yes"or"No"as to each of the following: The following criteria apply to large systems in addition to the Criteria above: The syswm serves a facility with a design flow of 10,000 gpd or greater(Large System) and the system is a significant threat to public health and safety and the environment because one or mare of the following conditions exist: 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•IWFAI or a mopped Zone tl of a public water supply well) 1`11e owner or operator of any suci+"tern shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Depaament for further information. ts.ais.d 04/29/77) lag* 3 of 10 UtC l75-177ti 11;cz KiNLIW—UtUVER PRUPERTIES P.@5/13 SUSSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (Continued) Address, l! &d ai--year,Ah 0,rtc+'& Ce,A-Z4t4'LL41. Date of Inspection. 01 SYSTEM CONDITIONALLY PASSES (COntinued) �l sewage backup or breakout or high static water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations- broken pipe(s)'am replaced, obstruction is removed distribution box is levelled or replaced _ The system requited pumping more that(four times a year due to broker~or obstruaed pi*J:' The system will pass inspection if(with approvai of the Board of Health): broken pipels)are replaced obstruction is removed Cl FURTHER EVALUATION 15 REQUIRED BY THE BOARD OF HEALTHt Conditions exist which require further evaluation by the Build'o{Health in order to determine if the syAern is failing to protect the . public health,safety and the environmerti. t) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT THE SYSTEM IS NOT FUNCTIONING IN A MANNER ' WHICH WILL PROTECT THE PUBLIC HEALTH AND 5AFOY AND THE ENVIRONMENT: Cesspool of privy is within 50 feet of a surface water Cesspool or privy is within 30 feet of a bordering vegetated wetland or a salt marsh. , a) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFFIFY AND THE ENVIRONMENT: I The system has a septic tank and soil absorption system(SAS)and the SAS is within 100 feet to a surface water supply or tributary to a surface wales'Supply. _ The system has n septic tank and soil absorption system and the SAS is within a Zone 1 of a public water supply well. The system has a septic tank and soil absorption system and the SAS is within 30 feet of a private water supply well. The system has a septic tank and soil absorption system and the M5 is less than 100 feet but So feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic compounds indicates that the well is free horn pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation not valid). 3) OTHER (t•tvfsed 24m/07) p+l� 7 04 to Town of Barnstable � BAMSTAeM = Department of Health,Safety, and Environmental Services 039. Public Health Division EDN1 � P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health April 3, 1998 John and Lenice G. Maher 31 Cedar Point Circle Centetville,MA 02632 ORDER TO COMPLY WITH 310 CMR 15.00,THE STATE ENVIRONMENTAL CODE, TITLE 5. The septic system owned by you located at 31 Cedar Point Circle, Centerville was inspected on November 4, 1996 by, Robert Bortolotti,a Massachusetts licensed septic inspector. The inspection of your septic system showed that your system has failed under the guidelines of 1995 TITLE 5 (310 CMR 15.00)due to the following: • Wastewater liquid was at the "working level"in the distribution box. According to the inspection report,the owner"needs a new leach pit." You are directed to hire a licensed Town of Barnstable septic system installer to submit a sketch diagram of a proposed system to the Town of Barnstable Health Division Office(Town Hall, 367 Main Street, Hyannis) that will bring the septic system into compliance with 310 CMR 15.00, The State Environmental Code, Title 5 within (30)thirty days of receipt of this notice. You are also directed to bring the septic system into compliance within sixty(60)days of receipt of this order letter. You are further directed to maintain the system by hiring a licensed septage hauler to pump the septic system to prevent discharge of sewage or effluent into the buildings, onto the surface of the ground, or in to surface waters. Any person aggrieved by any order issued by the local approval authority may appeal to any court of competent jurisdiction as provided for by the laws of the Commonwealth. ER OF THE BOARD OF HEALTH omas A.McKean,R.S.,C.H.O. Agent of the Board of Health q\health\dbfi les\title5 i.doc m SENDER: v ■Complete items 1 and/or 2 for additional services. I also wish to receive the y ■Complete items 3,4a,and 4b. following services(for an ■Print your name and address on the reverse of this form so that we can return this extra fee): card to you. ai i ■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address permit. y ■Write'Retum Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery N •The Return Receipt will show to whom the article was delivered and the date c delivered. Consult postmaster for fee. a 3.Article Addressed to: 4a.Article Number E 4b.Service Type �I ❑ Registered i6 Certified to ❑ Express Mail ❑ Insured ( o ❑ Return Receipt for Merchandise ❑ COD 7.Date of Delive r p 5.Received By:(Print Name) 8.Addressee's Address(Only if requested W— and fee is paid) t g 6.Signature: (Addressee or ent) a` X (�yl� PS Form 3811, December 1994 X 102595-97-B-0179 Domestic Return Receipt -First-c awviail UNITED STATES POSTAL SERVIFEl- A PostagdlTeev Paid USPS Permit No.G-1 0 -4 • Print youie m me.-,_addf6ss, and ZIP-Code-inl this-box. L i"ealth Division 'Town of Barnstable P.O.Box 534 Hyannis,Massachusetts 02601 YEB THE COMMONWEALTH OF MASSACHUSETTS ------- BOARD OF HEALTH , 11 ----------------_---------- ApplirFafion fors:D1ipugal Works Tamitrnrtion ramit Application is hereby made for a Permit to Construct (�or Repair ( ) an Individual Sewage Disposal System at: ............................ .W..ML... ....... .........--------------................. ---�------------------.............--- Location-Ad ess or Lot No. w er Address Installer Address . Type of Building Size Lot.__._1.�G?.__ ._s4t. t U Dwelling—No. of Bedrooms....... ..........................Expansion Attic ( ) Garbage Grinder ( ) Other—T e of Building No. of persons............................ Showers — Cafeteria Q' Other fixtures ----------------•------- - Desi n Flow................... gallons per person per day.- Total daily flow.._..__......_...._..�� W g �--�-------•---- --g P P P Y• Y -- ----------------dons. WSeptic Tank—Liquid capacity_�VOQ_gallons Length................ Width---------------- Diameter---------------- Depth................ x Disposal Trench—No..................... Width.................... Total Length...............,.... Total leaching area____._ __.........sq. ft. I .._.._ Seepage Pit No.---____.--. -- iameter-_-_-- �_-____- Depth below inlet.....__.-....... Total leaching area...- ft. Z Other Distribution box ( ✓ Dosing tank ( ) ~' Percolation Test Results Performed by TE!PZ -f'_1__.' ......................................... Date...�.'� _ _._.___._..:.... aTest Pit No. 1.....Z,,....minutes per inch Depth of Test Pit------�z--.... Depth to ground water------.._ .......... fi, Test Pit No. 2................minutes per inch Depth of Test Pit____________________ Depth to ground water........................ Pd Description o p Soil................... - - - . x - ------ -------------------- A-1J ---------------------------------------------------•----------------------------------------------- W :.:..... -•-------•---------------------------•--•-•--------•---•--............------......---------•----•---•------------------•----------------••-•-------•-•-•-•-•••-•--•..........M.--------•- U Nature of Repairs or Alterations—Answer when applicable------------------------------_-__.------.___-._--____------------_-_____-__-__•-•-_-•-_---_-. _ -•-----------------------------------------•-----•-•-------•--------------------------------------------.....---------------------------•-------------------------------------------................---- Agreement: The tindersignedt agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of iiTL, 5 of the State Sanitary de— The undersigned further agrees not to place the system in operation until a Cer •fica.te of C ance has b e i ue by t boa' of health. - / Date Application Approved By........... -•- ...'.... -•------------------------- � ---- -----•--- Date Application Disapproved for the following reasons---------------------------------------------------............................................................. ..------•••-•-••...---------•------•--•••-----•-•----------•-•-----------------------•-------- Date PermitNo------ ----------------------------------------------- Issued-------------------------------------------------------- Date YFEs.... -.........� i THE COMMONWEALTH OF MASSACHUSETTS r BARD OF HEALTH ,: is l':' .....'. ApplirFa#inn for Disposal Workii Tonotrnrtiun rrntit Application is hereby made for a Permit to Construct ( `l or Repair ( ) an Individual Sewage Disposal System'at: ...........:...._»......�+----Y-•:! E�r... 1%: l_r..r '.9cf:.. - ..........................................................f� � .•............-- :z. ` Location-Address A / r or Lot No. I/a! r.1 -z E,..I 4 -9 I'1_ '.�? `��., h......CJ 1 G t a� e .... _... • ..........•--......_ .. .... w ez Address -•-------•---------•-••---•--•-_ Installer Address Type of Building Size Dwelling-No. of Bedrooms............ __________________________Expansion Attic ( ) Garbage Grinder ( ) 44 Other—Type of Building ____________________________ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) dOther fixtures ................................ - W Design Flow....................;?_--J_________________gallons per person per day. Total daily flow..................... _ Q..........gallons. G' Septic Tank—Liquid;capacity.�!22_2gallons Length---------------- Width................ Diameter--._-.___-___.__ Depth................ Disposal Trench No_ ____________________ Width_________._.________ Total Length.................... Total leaching area........ ...........sq. ft. Seepage Pit No _.......J-------- ))iameter........ ....... Depth below inlet.................... Total leaching area___.:: `:K.2__sq. ft. z Other Distribution box'{ Dosing tank ( ) 1 r r Percolation Test Results Performed by}z-__X.'..?�--":�-'�_f'a_______________________________________ Date--- �--" "'r..�1:_______________.. w Test Pit No. I....... <t•....minutes per,inch Depth of Test Pit---------._C�____ Depth to ground water-------.'"........... Li! Test Pit No. 2................minutes per-inch Depth of Test Pit.................... Depth to ground water........................ --••---------- -••-------•-••-----•-----•-------------------------•--------•--••---_-----------------------------------------------------•---_•••-- 0. Description of Soil------------------- -•------------------•------•-=---------------------------------------------------•------------•----•-•--------------------------•-------_-••-- x.:.: ------------------------•-•----•- ........S•,F=•r..`-,...-•_-- W ......................-----------------------------------------------------------------------------------------------------............................................----•-•--•---••-•----•--........ UNature 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 TITi,l+. p 5 of the State Sanitary de—The,uridersigned further agrees not to place the system in operation until a Cer -ficate of lance has b e i ue by t boar of health. r..,...;;, .... Date Application Approved By----- �- '`` ••-- . �'•••-•- --------------------------- ••--•---- ...-----•r.....-'��e���` Date Application Disapproved for the following reasons-----------------•-------------------•------------------------------------------------------------------------_.. _ ...............................................................-------------------------------------------------------------------------------------------------------- ------------------------------- Date PermitNo......................................................... Issued....................................................... Date \ - THE COMMONWEALTH OF MASSACHUSETTS �,. j BOARD OF HEALTH If 11 ........... .. :.................OF.... i .... tF I....... al . C_Urrtif irate of Tomplianrr THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( ) or Repaired ( ) by----------- _ .------•..............................................•--•--------------------------------•---------.._......._..-----•-------•----------------....._....-------------- In taller at......... L ._..--•-----4 - --- %�j..... i 4� I -- has been installed in accordance with the provisions of TI T j of The State Sanitary Code as described in the application for Disposal Works Construction Permit No......................................... dated___..___-_..-..__--_-.-_-_---_____-____________ THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONST UED AS A GUA ANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. ((�� / g.s DATE...........--------q �-,---- Inspector... - = - THE COMMONWEALTH OF MASSACHUSETTS BOARD40F HEALTH -� .w............OF d�.. qW NO. FEE.... Disposal Works C�nnirnrtion firrutit Permissionis hereby granted__-_ ._ t ....................:..........----------------------•----------------------------••-•--•----.___-•------........_..-- to Construct ) or Repair ( ) an I vldu Sewage Disposal tem atNo......... ' ..... - f ,,, ^'.{ t`` .---------------------------------- Street 31 as shown on the application for Disposal Works Construction Permit o `!_U�f_ Dated.._ _: OZ _______, x Board of jiealth , DATE................... --`=I�-•`-----•--•-----........................... FOR. 12$5 HOBBS & WARREN, INC.; PUBLISHERS i �? IATI d<� f i. SEWAGE PERMIT NO. V I,L I N S T A L-L-E R'S N A M E i J�A �."M B,ACKHOE SERVICE' JONN A, AALTO BACKS 150 ,Wal Wss't Barnstable es arnstablec Mass„�026�68 e U I L D E R OR OWNER j W \ R P o op DATE PERMIT ISSUED c1,/3-- 57 DAT E C. OMPLIANCE ISSUED �,� r .i� ..� V T ` r / . �.flNt �,�� � / f �y�' � � cr ,� ��� i � i �� J / �: ./ � a r r / � � � � / , J i i '�' � �, a _ � �` �- � ��� G_ �, - �.. c � � � -� �./ d i,� ' I L J 30161 32 33 LOT 5 CENTERVILLE 29 N60•09'25'sE 165.63 CEDAR PARCEL ID: �, TBM = COR. OF POINT Ov-�E 2a 228/128 �`\ •�� APRON f R W, M T 14 EL=3 .00 I R C L E q/N ST D' IVEWAY PINE ST'N PARTIAL 5 FT. o� N O SOIL REMOVAL �' j 0 W W 'O v ; p i 3Q TP LOCUS p _ _ \\ x PROP. 1,500G 26 , - ___- !`. •�B "s N3� LOCUS MAP SEP. TANK PARCEL ID: EXIST. 1,000G =� ` — ' F- LOCUS INFORMATION 228/134 SEP. TANK S ____ __-` _ PLAN REF: LCP# 40754-A TITLE REF: CTF# 211375 k PARCEL ID: MAP 228 PAR. 113-004 V O� ZONING: "RC" FLOOD ZONE: "X" COMMUNITY PANEL: 25001CO564J DATED:07/16/14 °cam SEPTIC SYSTEM REPAIR PLAN ,yy LOCATED AT: LOT 4 ry 31. CEDAR POINT CIRCLE AREA=I.2ACREs I CEN TER VI LLE, MA. LOT 3 PREPARED FOR JOANNE MCATEER DECEMBER 15, 2016 OF ssP, AL 0. E I,' A s 0. 11 0 �� \ $TES Zia #I TAR\p� Alk O ry, iL P� SCALE: 1"=30' MEYER & SONS, INC. G�oF iL AL P.O.P.O. BOX 981 PROPOSED CONTOUR EAST SANDWICH, MA. 02537 ® PROPOSED SPOT GRADE i �1llc CREEK -- 98 -- EXISTING CONTOUR PH: (508)360-3311 A 'L AL + 96.52 EXISTING SPOT GRADE FAX: (774)413-9468 W— EXISTING WATER SERVICE meyerdndSOnSInCC�gt1141I.COC11 TEST PIT SHEET 1 OF 2 J 1889 1 NOTE: MAGNETIC TAPE TO BE PLACED OVER ALL COVERS NOTE:' TO PREVENT BREAKOUT, THE PROPOSED FINISH OPTIC TAN , GRADE SHALL NOT BE < EL•26.10 FOR A DISTANCE EL=35.24E PROPOSED D-BOX INSTALL RISERS & COVERS OVER INLET & � 15' AROUND THE PERIMETER OF THE S.A.S. GENERAL NOTES: OUTLET AND SET TO 6" OF FINISH GRADE PROPOSFt) SAS 1. ALL CHANGES TO THIS PLAN MUST BE APPROVED BY THE LOCAL INSTALL RISER & COVER INSTALL LOCKING COVERS IF AT FINISH GRADE � INSTALL A RISER OVER ONE CHAMBER (MIIN) - SET TO 6' OF GRADE AND SET TO 3" OF F.G. BOARD OF HEALTH AND THE DESIGN ENGINEER. • F.G. EL.=29.St F.G. EL.=28.8t F.G. EL: 30.Ot ? 2. ALL WORK AND MATERIALS SHALL CONFORM TO THE REOUIREMENTS OF THE STATE ENVIRONMENTAL CODE, TITLE V. AND ANY APPLICABLE F.G. EL: 31.0(MAX.) VENT LOCAL RULES AND REGULATIONS, EXCEPT AS REQUESTED BELOW: - 310 CMR 15.405 (1) (B): 9" MIN COVER/ wamwenam N wMannummi L, 1) A 2.0 Fr. VARMCE FROM 31OCMR15.221(7) TO ALLOW LEACHING 36" MAX COVER L = 25' L = 40'(MAX) TO BE 5.00 FT (MAX) BELOW GRADE VS REO'D 3 FT. (H20AVFNT pROV1DED) ® S=1% (MIN.) EL=27.28t 0 S=1% (MIN.) 0S=1°K (MIN.) 2" OF 3 3.'THE SEWAGE DISPOSAL SYSTEM SHALL NOT BE BACKFILLED PRIOR 4"SCH40 PVC 4"SCH40 PVC' 4"SCH40 PVC /8" DOUBLE WASHED 3/4" - 1-1/2" TO INSPECTION AND APPROVAL BY THE BOARD OF HEALTH AND THE 10" / STONE OR FILTER FABRIC DOUBLE WASHED STONE DESIGN ENGINEER. 14' 6 # 4. ANY CONDITIONS ENCOUNTERED DURING CONSTRUCTION DIFFERING INV.=26.20 �,uouro ENGINEERO HOBE SHOWN HEREON SHALL (,ONE REPORTED TO THE DESIGN L.� INV.=2S.9S ®®®®• 0 ®®®® 5. ALL ELEVATIONS BASED ON ASSUMED DATUM. GAS BAFFLE PROPOSED ®®®®®®®®®®® 6. THE DESIGN ENGINEER IS NOT RESPONSIBLE FOR THE FAILURE OF 1 ®®®®®®®®®®® INV.=ZS.50 ®®®®®®®®®®® THE CONTRACTOR OR OWNER TO NOTIFY THE LOCAL BOARD OF INV.=25.70 DB-5 HEALTH FOR PROPER INSPECTIONS DURING CONSTRUCTION. PROPOSED 1,500 GALLON SEPTIC TANK 42jo - 3.2 ' 3 X 8.5' 3.25' 7. DWELLING IS SERVICED BY MUNICIPAL WATER. 8 TO ALL AREAS DITION AGREED UING PON BETSTRUCTION SHALL BE WEEN OWNS AND CONTRACTOR. EXIST. SEWER OUTLET EFFECTIVE LENGTH = 32.0 9. IT SHALL BE THE RESPONSIBILITY OF THE CONTRACTOR TO VERIFY THE INV. ELEV.= 25.10 LOCATION OF ALL UNDERGROUND UTILITIES, PRIOR TO STARTING WORK. 10. EXISTING LEACHING TO BE PUMPED, CRUSHED AND REMOVED PER TITLE 5. BREAKOUT REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. NOTES: 1) CONTRACTOR SHALL VERIFY ALL EXISTING TOP CONC. ELEV.= 261A0 EL. 26.10 11. 48 HOUR NOTICE FOR ENGINEER CERTIFICATION . . PIPE INVERTS PRIOR TO CONSTRUCTION ; 12. THIS PLAN IS TO BE USED FOR SEPTIC SYSTEM PURPOSES ONLY 2) TANK AND D-BOX SHALL BE SET LEVEL AND INV. ELEV.= 25.10 66 AND IS NOT TO BE CONSIDERED A PROPERTY LINE SURVEY TRUE TO GRADE ON A MECHANICALLY COMPACTED y aaaa®6B 13. NO KNOWN PRIVATE WELLS WITHIN 100 FT. OF PROPOSED LEACHING aaaaaaa SIX INCH CRUSHED STONE BASE, AS SPECIFIED IN aaaaaaa 14. ALL PIPING TO BE 4" SCH 40 ® 1/8-/FT (UNLESS SPEC. ) 310 CMR 15.221(2) BOTTOM EL.= 23.10 4' 5 FT. ¢' 15. THE DESIGN OF THIS SYSTEM DOES NOT ALLOW I. 3) INSTALL INLET & OUTLET TEES W/ FOR THE USE OF A GARBAGE GRINDER. GAS BAFFLE AS REQUIRED SEPARATION 5.75 FT. EFFECTIVE WIDTH = 13' 16. No WETLANDS WITHIN 100 FT. OF PROPOSED LEACHING j SOIL ABSORPTION SYSTEM (SECTION 17. REMOVE ALL UNSUITABLE SOILS 5 FT AROUND LEACHING TO SEPTIC SYSTEM PROFILE BOTTOM OF TESTHOLE EL: 17.35 (500 GALLON (H20) LEACH CHAMBER) EL. 22.60 OR TOP OF "C" LAYER AND REPLACE WITH CLEAN MEDIUM SAND PER TITLE 5. N.T.S. SOIL LOGS P#:15219 DESIGN CRITERIA DATE: DECEMBER 5, 2016 NUMBER OF BEDROOMS: EXIST. 3 BEDROOM/"4 BEDROOM DESIGN SOIL EVALUATOR: DARREN M. MEYER, RS, CSE SOIL TEXTURAL CLASS: CLASS 1 (0.74 GPD/SF) DESIGN PERC RATE: <2 MIN/IN WITNESS: DAVE STANTON, BARNSTABLE HEALTH DAILY FLOW: 110 G.P.D. X 4 BR DESIGN FLOW: 440 G.P.D. EleGARBAGE GRINDER: NO (not designed for garbage grinder) 28. TP-1 Depth Elev. TP-2 Depth Elev. TP-3 Depth SEPTIC TANK: 440 28.70 0° p Elev. TP-4 Depth � gpd x 200% = 880 .gpd USE PROP. 1,50OG SEPTIC TANK 28.60 0" 31.05 0" FILL FILL A LOAMY SAND 30.95 A-- 0" LEACHING AREA REQUIRED: '(440)/0.74 = 594.59 S.F. 26.45 27LOAMY SAND s q 26.35 27" IOYR 3/2 LOAMY SAND A LOAMr SAND 30.38 B 8" 30.32 t01R 4/2 8" USE THREE (3) 500 GALLON (1-120) PRECAST LEACH CHAMBERS ,25.28 41" 10YR 3/2 LOAMY SAND B LOAMY SAND 25.18 41" IOYR 6/6 W/ 3.25' STONE ON ENDS AND 4' ON SIDES: 32' L x 13' W x 2' D B LOAMY L SAND B LOAMY SAND 28.05 36" 27.95 1 OYR 5/8 36" 22.70 C 72" 22.60 10YR 6 s 72" MEDIUM MEDIUM C1 C1 - BOTTOM AREA: 32 x 13 = 416 SF PERC TEST C SAND TEST NO SAND SIDE AREA: (32 + 13) X 2 X 2 = 180 SF ® 21so MEDIUM SAND MEDIUM z.SY 7/a 2sY 7/4 SAND • 270 TOTAL SQUARE FEET PROVIDED = 596 vs. 594.59 REQ'D 2.5Y 7/4 2sY 7/3 I` DESIGN FLOW PROVIDED: 0.74(596 S.F.) = 441 G.P.D. vs. 440 G.P.D. req'd 17.45 135" 17.35 135" 21.05.- 120 20.95 120" OF 00 PROPOSED SEPTIC SYSTEM UPGRADE PLAN PERC RATE <2 MIN/IN. (*Cl" HORIZON) ARREN M. NO GROUNDWATER OBSERVED � PERC RATE <2 MIN/IN. (-Cl-( HORIZON) E 31 CEDAR POINT CIRCLE, CENTERVILLE, MA NO GROUNDWATER OBSERVED ( y I14 Prepared for: Mcoteer f r O System Design and Topography Plan by: SCALE DRAWN DATE • 1, Darren M. Meyer, R.S., CSE, hereby certify that I am currently approved by MADEP pursuant to 310 CMR 15.017 RfC/ MEYER&SONS,INC. N.T.S. DMM 12/2O/16 to conduct soil evaluations and that the above analysis has been performed by me consistent_ with NITAR`p� PO BOX981 requirements of 310 CMR 15.017. 1 further certify that I have passed the Soil Evol. Exam in October, 1999. REV DATE�� 1► EASTSANDWICH,M402537 CHECKED SHEET NO. lr 5oe-"-2M - DMM 2 of 2 ! I ! _ I I I - I , , • 00-- -- - . I , i I I ' 1 I I I , i I � I I ' l I N ' I i I I , i .; I IPA-' i i I I - I I , I I _.. - -- ---.r -- -- --- -- -. ..... I.. = : i I 1 ! i • I ! - I I I I i M , m In 0 I I , I 1 i r i i y -' I, I I I ; Y ! 1-41 I I ! i I I-V � ) 1 • I , t • I _ i i j I I , i I ............ ----------- i i i Q IF • ii ... .... .... 17 1 - - - - - - - - - - - - - - - - - - - - - - z 0 Q Q Q Ld Z 34'-0" NEW ADDITION 0 4' DIA. CONCRETE FOOTING 16" DIA SONOTUBE PIER 1' 10'-8" 10'-8" 34' First Floor & Deck Addition 48" Pier Location Plan JAMES C. SCHROCK, P.E ��► jAOFly,� McAteer Residence . 45 Starlight Lane � JAMES C. 31 Cedar Point Circle c SCHROCK Eastham, MA 02642 STRUCTURAL Centerville, Ma ph (508)240-2535 NO.43113 fx (508)240-1464 A��,�9FCISTEA1`��Q Sketch S K — 2 t jim@jimschrock.com NAL 11)j Q 0 10-29-02 O r— O III w v I e rTl z o I-1 -� ,Iv z M m o -III C- 0ao � m ox o � oK � -+ 70 1IIII � 10 oM mz � � D � n -0 r 1=1 -► rn II ,n m z ' w _° m o zO = D Cu Z 4iw U) m o 4 n � orn v m I _� Z - O o O O V .� n PiW z m —�I II` D o o 0 m = D o o (J I -uN � CDmZ > FT] O o m - Z D Z D —� U) -11 l D m O D K I - -u ()Icn o -o Z — D 41- — m z o I_ Dx, �4 z 0') 1—��i' U) m X- C D m U) Z -N-, m n CD X 0M n � Z _� � m O � 0') D � C- cn r- cn ACC � � m O OO n � m C) D � -�-I O C U) tN OF MCI C-) 70 C m Z m KCD JAMES C. -1 D SC '$CHROCK Z O CO �j D A RAL �431 z D n 0. 13 maw trn D y McAteer Residence CDD JAMES C. SCHROCK, P.E. 31 Cedar Point Circle 45 Starlight Lane W Z Centerville, Ma 1 1 O Eastham, MA 02642 o f'o m ph (508)240-2535 First Floor & Deck Addition 2 jim (508)@jimschrock.c 4 ock.com I 1 d i N f I Sj S i LIP ��''7 as .. � r �� /f// a `'.,1"I"� �L� � � ►...,�`'� ..4 ...y '` GEyy P \ AP ;vp DO— C. �Q f - 19 � 2'1 Z — _ —`-.�� _ ._ � __ _ — -- _ � —i _- _ � �� �iL�lvr5'�`E�L��:_;+ �.�`t.�"T�.' `�U�'...k/ '/^►�-S �- `D ��,p15 • IN 20 f I � I. IF _ etc t)14 A L T>rr P- 4s o- 1141,54 r� 2�►d T�S� fit.. �o .� t�i� CAM 15G7 •� 2 .. _ �. r mow. DKT �lug/ 1 uJ. I l."'O L7 27 I ':C 7�?J' Lb Z i Y.b� _ ���.� , �L"�f'�t,. ;r,;a l�'�►t j,�.,l.� � t ; for 1 m 12. ._ _l :-,c„�r 5, d �._ 1 GAT� �,- '� AT '�'t•!� �•,�,�c ...t tiGF �jt�c�i t.� { t.(o wA .- GD.�vt pG�"�� t r�.� t� ,� �1��.t.�►�� A OJT;. 5 L6��3 -. (2t36 o1 2-e-xA b jT";, ' T'47; `i"t:t,4f N of 13-&Z A i t